Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
HO CH, YU MWV, LEUNG YT
Affiliation :
The Department of Dietetics, Queen Mary Hospital
Introduction :
Compliance with protein-restricted diet in patients with chronic kidney disease (CKD) can alleviate uremic symptoms and progression to renal replacement therapy. The associated insufficient energy intake can predispose to malnutrition and reduced physical functionality.
Objectives :
This cross-sectional study aimed to examine dietary energy intake, nutritional status and muscle strength among non-dialysis CKD patients adhering to protein-restricted diet.
Methodology :
Thirty-five non-dialysis CKD stage 3-5 adult patients who attended the dietetic outpatient clinic of Queen Mary Hospital from 2018 to 2021 were recruited in the study. At time of recruitment, they had been reviewed by dietitians for at least 6 months from their first consultations to ensure protein restriction compliance, initially less than 0.8g/kg/day and progressing towards 0.6g/kg/day. Satisfactory protein restriction compliance was defined as dietary protein intake less than 0.8 g/kg/day in this study. The dietary energy and protein intake of each patient were assessed by dietitians at recruitment. In a subgroup of the cohort (17 patients), phase angle, an indicator of nutritional status, and dominant handgrip strength for muscle strength assessment were measured by a bioelectric-impedance analyser (MC-980, Tanita) and a dynamometer (JAMAR) respectively at recruitment. Dietary energy and protein intake per body weight, phase angle and average handgrip strength were compared between patients with satisfactory protein restriction compliance (SC) and patients with unsatisfactory compliance (UC). Level of significance is P<0.05.
Result & Outcome :
19 SC patients consumed 0.6g/kg/d (IQR:0.5, 0.7) of protein, compared to 1.0g/kg/d (IQR:0.9, 1.3) in 16 UC patients (P<0.001). They had significantly lower energy intake than UC patients (22.7kcal/kg/d (IQR:18.2, 24.2) Vs 28.3kcal/kg/d (IQR:25.9, 32.3), P=0.002). Age and gender-adjusted logistic regression illustrated satisfactory protein restriction compliance was negatively associated with energy intake per body weight (B= -7.3, 95%CI -10.1, -4.4). In subgroup analysis, SC patients had a lower phase angle (4.5◦ (IQR:4.2, 5.1)) than UC patients (5.5◦ (IQR:4.9, 5.6)). Their handgrip strength (20.5kg (IQR:16.7, 26.3)) was weaker than UC patients (23.0kg (IQR:16.7, 27.6)). Both parameters’ comparisons were statistically insignificant due to limited sample size. This study demonstrated that the reduced energy intake associated with adherence to protein restricted diet might compromise nutritional status and muscle strength among non-dialysis CKD patients. Nutritional measures achieving adequate energy intake along with protein restriction for CKD management are warranted to prevent malnutrition and muscle strength decline.
