Effects of Dietary Intervention on Nutritional Status in Elderly Individuals with Chronic Kidney Disease

Abstract

The prevalence of chronic kidney disease (CKD) is rising, especially in elderly individuals. The overlap between CKD and aging is associated with body composition modification, metabolic abnormalities, and malnutrition. Renal care guidelines suggest treating CKD patient with a low-protein diet according to the renal disease stage. On the other hand, geriatric care guidelines underline the need for a higher protein intake to prevent malnutrition. The challenge remains of how to reconcile a low dietary protein intake with insuring a favorable nutritional status in geriatric CKD populations. Therefore, this study aims to evaluate the effect of a low-protein adequate energy intake (LPAE) diet on nutritional risk and nutritional status among elderly CKD (stage 3-5) patients and then to assess its impact on CKD metabolic abnormalities. To this purpose, 42 subjects [age ≥ 65, CKD stage 3-5 in conservative therapy, and Geriatric Nutritional Risk Index (GNRI) ≥ 98] were recruited and the LPAE diet was prescribed. At baseline and after 6 months of the LPAE diet, the following data were collected: age, sex, biochemical parameters, anthropometric measurements, body composition, and the GNRI. According to their dietary compliance, the subjects were divided into groups: compliant and non-compliant. For the compliant group, the results obtained show no increased malnutrition risk incidence but, rather, an improvement in body composition and metabolic parameters, suggesting that the LPAE diet can provide a safe tool in geriatric CKD patients.

Keywords: CKD; GNRI; geriatric nutritional risk; low-protein diet; malnutrition risk.

Figure 1

Percentage change in TG/HDL-ratio, blood uric acid, blood phosphorus, and PTH from compliant and non-compliant patients with CKD, before and after 6 months on the LPAE diet. * p values < 0.05 vs. Non-Compliant group. Abbreviations: TG/HDL ratio, triglyceride/high-density lipoprotein ratio; PTH, parathyroid hormone.