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Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study.
Kidney Int. 2000 Apr; 57(4):1688-703.KI

Abstract

BACKGROUND

The relationship between the protein-energy nutritional status and renal function was assessed in 1785 clinically stable patients with moderate to advanced chronic renal failure who were evaluated during the baseline phase of the Modification of Diet in Renal Disease Study. Their mean +/- SD glomerular filtration rate (GFR) was 39.8 +/- 21.1 mL/min/1.73 m2.

METHODS

The GFR was determined by 121I-iothalamate clearance and was correlated with dietary and nutritional parameters estimated from diet records, biochemistry measurements, and anthropometry.

RESULTS

The following parameters correlated directly with the GFR in both men and women: dietary protein intake estimated from the urea nitrogen appearance, dietary protein and energy intake estimated from dietary diaries, serum albumin, transferrin, percentage body fat, skinfold thickness, and urine creatinine excretion. Serum total cholesterol, actual and relative body weights, body mass index, and arm muscle area also correlated with the GFR in men. The relationships generally persisted after statistically controlling for reported efforts to restrict diets. Compared with patients with GFR > 37 mL/min/1.73 m2, the means of several nutritional parameters were significantly lower for GFR between 21 and 37 mL/min/1.73 m2, and lower still for GFRs under 21 mL/min/1.73 m2. In multivariable regression analyses, the association of GFR with several of the anthropometric and biochemical nutritional parameters was either attenuated or eliminated completely after controlling for protein and energy intakes, which were themselves strongly associated with many of the nutritional parameters. On the other hand, few patients showed evidence for actual protein-energy malnutrition.

CONCLUSIONS

These cross-sectional findings suggest that in patients with chronic renal disease, dietary protein and energy intakes and serum and anthropometric measures of protein-energy nutritional status progressively decline as the GFR decreases. The reduced protein and energy intakes, as GFR falls, may contribute to the decline in many of the nutritional measures.

Authors+Show Affiliations

National Institutes of Diabetes, Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

10760105

Citation

Kopple, J D., et al. "Relationship Between Nutritional Status and the Glomerular Filtration Rate: Results From the MDRD Study." Kidney International, vol. 57, no. 4, 2000, pp. 1688-703.
Kopple JD, Greene T, Chumlea WC, et al. Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study. Kidney Int. 2000;57(4):1688-703.
Kopple, J. D., Greene, T., Chumlea, W. C., Hollinger, D., Maroni, B. J., Merrill, D., Scherch, L. K., Schulman, G., Wang, S. R., & Zimmer, G. S. (2000). Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study. Kidney International, 57(4), 1688-703.
Kopple JD, et al. Relationship Between Nutritional Status and the Glomerular Filtration Rate: Results From the MDRD Study. Kidney Int. 2000;57(4):1688-703. PubMed PMID: 10760105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study. AU - Kopple,J D, AU - Greene,T, AU - Chumlea,W C, AU - Hollinger,D, AU - Maroni,B J, AU - Merrill,D, AU - Scherch,L K, AU - Schulman,G, AU - Wang,S R, AU - Zimmer,G S, PY - 2000/4/12/pubmed PY - 2000/5/16/medline PY - 2000/4/12/entrez SP - 1688 EP - 703 JF - Kidney international JO - Kidney Int VL - 57 IS - 4 N2 - BACKGROUND: The relationship between the protein-energy nutritional status and renal function was assessed in 1785 clinically stable patients with moderate to advanced chronic renal failure who were evaluated during the baseline phase of the Modification of Diet in Renal Disease Study. Their mean +/- SD glomerular filtration rate (GFR) was 39.8 +/- 21.1 mL/min/1.73 m2. METHODS: The GFR was determined by 121I-iothalamate clearance and was correlated with dietary and nutritional parameters estimated from diet records, biochemistry measurements, and anthropometry. RESULTS: The following parameters correlated directly with the GFR in both men and women: dietary protein intake estimated from the urea nitrogen appearance, dietary protein and energy intake estimated from dietary diaries, serum albumin, transferrin, percentage body fat, skinfold thickness, and urine creatinine excretion. Serum total cholesterol, actual and relative body weights, body mass index, and arm muscle area also correlated with the GFR in men. The relationships generally persisted after statistically controlling for reported efforts to restrict diets. Compared with patients with GFR > 37 mL/min/1.73 m2, the means of several nutritional parameters were significantly lower for GFR between 21 and 37 mL/min/1.73 m2, and lower still for GFRs under 21 mL/min/1.73 m2. In multivariable regression analyses, the association of GFR with several of the anthropometric and biochemical nutritional parameters was either attenuated or eliminated completely after controlling for protein and energy intakes, which were themselves strongly associated with many of the nutritional parameters. On the other hand, few patients showed evidence for actual protein-energy malnutrition. CONCLUSIONS: These cross-sectional findings suggest that in patients with chronic renal disease, dietary protein and energy intakes and serum and anthropometric measures of protein-energy nutritional status progressively decline as the GFR decreases. The reduced protein and energy intakes, as GFR falls, may contribute to the decline in many of the nutritional measures. SN - 0085-2538 UR - https://www.unboundmedicine.com/medline/citation/10760105/Relationship_between_nutritional_status_and_the_glomerular_filtration_rate:_results_from_the_MDRD_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)46919-4 DB - PRIME DP - Unbound Medicine ER -