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Abstract
Background
Low protein intake (LPI) has been suggested as a treatment for chronic kidney disease (CKD). However, protein intake is essential for bone health.
Methods
We studied the database of the National Health and Nutrition Examination Survey, 2005–2010. Basic variables, metabolic diseases, and bone density of different femoral areas were stratified into four subgroups according to different protein intake (DPI) (that is, <0.8, 0.8–1.0, 1.0–1.2, and >1.2 g/kg/day).
Results
Significant differences were found among all lumbar area bone mineral density (BMD) and T-scores (p < 0.0001). There was an apparent trend between a decreasing BMD in the CKD groups with increasing DPI in all single lumbar spines (L1, L2, L3, and L4) and all L spines (L1-L4). Compared with DPI (0.8–1.0 g/day/kg), higher risks of osteoporosis were noticed in the subgroup of >1.2 g/day/kg over L2 (relative risk (RR)=1.326, 95% confidence interval (CI)=1.062–1.656), subgroup >1.2 g/day/kg over L3 (RR = 1.31, 95%CI = 1.057–1.622), subgroup <0.8 g/day/kg over L4 (RR = 1.276, 95%CI = 1.015–1.605), subgroup <0.8 g/day/kg over all L spines (RR = 11.275, 95%CI = 1.051–1.548), and subgroup >1.2 g/day/kg over all L spines (RR = 0.333, 95%CI = 1.098–1.618). However, a higher risk of osteoporosis was observed only in the non-CKD group. There was an apparent trend of higher DPI coexisting with lower BMD and T scores in patients with CKD. For osteoporosis (reference:0.8–1.0 g/day/kg), lower (<0.8 g/day/kg) or higher DPI (>1.2 g/day/kg) was associated with higher risks in the non-CKD group, but not in the CKD group.
Conclusions
In the CKD group, LPI for renal protection was safe without threatening L spine bone density and without causing a higher risk of osteoporosis.
KEY LEARNING POINTS
A low-protein diet should be encouraged in patients with CKD, but protein is essential for bone health. In this study, we showed that a low-protein diet did not affect lumbar bone density. Therefore, in the care of CKD, a low-protein diet is beneficial for renal function and without harm to lumbar bone health.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Author contributions statement
Chia-Lin Lee, Wei‑Ju Liu, Ching-Hsien Chen, and Shang-Feng Tsai conceived the study. Shang-Feng Tsai and Chia-Lin Lee developed the theory and performed computations. Chia-Lin Lee, Wei‑Ju Liu, and Ching-Hsien Chen verified the analytical method. All authors discussed the results and contributed to the final manuscript. Shang-Feng Tsai wrote the manuscript with input from all the authors. Chia-Lin Lee and Wei‑Ju Liu conceived the study and were in charge of the overall direction and planning.
Disclosure statement
No potential conflict of interest was reported by the author(s).