High-protein diet with renal hyperfiltration is associated with rapid decline rate of renal function: a community-based prospective cohort study

Abstract

Background The effect of a high-protein diet with renal hyperfiltration (RHF) on decline of kidney function has rarely been explored. We investigated the association between a high-protein diet, RHF and declining kidney function. Methods A total of 9226 subjects from the Korean Genome and Epidemiology Study, a community-based prospective study (2001–14), were enrolled and classified into quartiles according to daily amount of protein intake based on food frequency questionnaires. RHF was defined as estimated glomerular filtration rate (eGFR) with residuals of >95th percentile after adjustment for age, sex, history of hypertension or diabetes, height and weight. Rapid decline of renal function was defined as decline rate of eGFR >3 mL/min/1.73 m2/year. Results The relative risk of RHF was 3.48-fold higher in the highest than in the lowest protein intake quartile after adjustment for confounding factors [95% confidence interval (CI) 1.39–8.71]. The mean eGFR decline rate was faster as quartiles of protein intake increased. Furthermore, the highest quartile was associated with 1.32-fold increased risk of rapid eGFR decline (95% CI 1.02–1.73). When subjects were divided into two groups with or without RHF, the highest quartile was associated with a rapid decline in renal function only in RHF subjects (odds ratio 3.35; 95% CI 1.07–10.51). The sensitivity analysis using the Korean National Health and Nutrition Examination Survey (2008–15) data with 40 113 subjects showed that higher quartile was associated with increased risk for RHF. Conclusions A high-protein diet increases the risk of RHF and a rapid renal function decline in the general population. These findings suggest that a high-protein diet has a deleterious effect on renal function in the general population.

Dietary Protein Intake and Single-Nephron Glomerular Filtration Rate

“…Although not observed in this study, an association between high protein intake and elevated eGFR has been reported in several studies [7,37]. This discrepancy might be caused by a difference in glomerular hyperfiltration between the single-nephron level and the whole-kidney level [5].…”

“…In animal models [3,4] and humans [5,6], dietary protein was shown to increase intrinsic acid production, which can cause kidney injury due to acid retention-induced kidney endothelin and aldosterone production. Furthermore, increased dietary protein per se was shown to induce kidney injury through a hemodynamic mechanism of renal hyperfiltration in humans [7] and experimental animals [8]. However, the direct association between protein intake and glomerular hemodynamic response remains poorly understood.…”

Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet

“… 30 , 31 , 32 , 33 For example, adherence to a healthy plant-based diet (fruits, vegetables, whole grains, nuts, and legumes) was associated with lower risk for developing CKD, 30 , 31 whereas a higher animal-based protein intake was associated with increased risk for kidney hyperfiltration and rapid kidney function decline. 34 Similarly, a Mediterranean-style diet (ie, high in fruits and vegetables) was associated with lower risk for incident loss of kidney function (estimated glomerular filtration rate [eGFR] < 60 mL/min per 1.73 m 2 ). 32 Although red meat intake is strongly associated with increased risk for kidney failure in the general population, substituting 1 daily serving of red meat with another source of protein was shown to reduce the risk for kidney failure by 62% (for poultry), 50% (for soy, legumes, or eggs), or 49% (for fish).…”

Preoperative High-Protein Diet Can Improve The Serum Albumin Levels of Patients Undergoing Total Knee Arthroplasty

“…Our study presents several limitations. First, we excluded patients with renal and hepatic diseases, and therefore the safety of a high-protein diet for these patients must be assessed because of its potential effects on renal function [29,35]. Second, although we asked patients to fast for 6-8 hours before blood collection, some patients, especially at outpatients visit, may have failed to follow it, which would affect our laboratory test results.…”