In the Journals

Higher protein intake linked to more rapid kidney function decline after myocardial infarction

A study of 2,248 patients, most of whom had normal kidney function at baseline, found patients who had higher protein intakes experienced a more rapid decline in kidney function following myocardial infarction.

“Post-myocardial infarction (MI) patients, compared with the general population, have a doubled rate of annual kidney function decline of about 2 mL/min/1.73 m2, and are thus at risk for [chronic kidney disease] CKD,” Kevin Esmeijer, MD, of the department of nephrology at Leiden University Medical Center in the Netherlands, and colleagues wrote. “Classic cardiovascular risk factors, such as diabetes, smoking and hypertension, can only explain part of the accelerated kidney function decline. Identification of novel modifiable risk factors is important for targeted prevention of kidney function decline and may improve life expectancy in post-MI patients.”

Patients included in the study were aged between 60 and 80 years and had a mean cystatin C-based eGFR of 82 mL/min/1.73 m2 at baseline. Researchers collected dietary data using a 203-item food frequency questionnaire and divided total protein intake into animal (subdivided into meat or dairy) or plant protein. Mean total daily protein intake was determined to be 71 grams/kg ideal body weight (two-thirds from animal sources). Researchers noted, at baseline, eGFR varied for patients of different protein intakes (daily total protein intake of < 0.80 g/kg = 77 mL/min/1.73 m2; intake of 1.20 g/kg = 85 mL/min/1.73 m2).

After 41 months of follow-up, they observed each incremental total daily protein intake of 0.1 g/kg ideal body weight was associated with an additional annual eGFRcysC decline of -0.12 mL/min/1.73 m2. Results were similar for both animal and plant protein.

foods high in protein 
Patients who had higher protein intakes experienced a more rapid decline in kidney function.
Source: Adobe Stock

Furthermore, patients who had a daily total protein intake of at least 1.20 g/kg ideal body weight experienced a twofold faster annual eGFRcysC decline compared with those who consumed less than 80 g/kg (-1.60 mL/min/m2 vs. -0.84 mL/min/1.73 m2).

“This is the first and largest cohort of older state-of-the-art drug-treated post-MI patients showing that high-protein intake is associated with accelerated kidney function decline,” the researchers wrote. “Our findings are in line with the current KDIGO guidelines recommending to limit daily total protein intake to [less than] 1.30 g/kg body weight in adults at risk for CKD, and to restrict protein intake to 0.60-0.80 g/kg/day in patients with diabetes or eGFR [of less than] 30 mL/min/1.73 m2.” – by Melissa J. Webb

Disclosures: Esmeijer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

A study of 2,248 patients, most of whom had normal kidney function at baseline, found patients who had higher protein intakes experienced a more rapid decline in kidney function following myocardial infarction.

“Post-myocardial infarction (MI) patients, compared with the general population, have a doubled rate of annual kidney function decline of about 2 mL/min/1.73 m2, and are thus at risk for [chronic kidney disease] CKD,” Kevin Esmeijer, MD, of the department of nephrology at Leiden University Medical Center in the Netherlands, and colleagues wrote. “Classic cardiovascular risk factors, such as diabetes, smoking and hypertension, can only explain part of the accelerated kidney function decline. Identification of novel modifiable risk factors is important for targeted prevention of kidney function decline and may improve life expectancy in post-MI patients.”

Patients included in the study were aged between 60 and 80 years and had a mean cystatin C-based eGFR of 82 mL/min/1.73 m2 at baseline. Researchers collected dietary data using a 203-item food frequency questionnaire and divided total protein intake into animal (subdivided into meat or dairy) or plant protein. Mean total daily protein intake was determined to be 71 grams/kg ideal body weight (two-thirds from animal sources). Researchers noted, at baseline, eGFR varied for patients of different protein intakes (daily total protein intake of < 0.80 g/kg = 77 mL/min/1.73 m2; intake of 1.20 g/kg = 85 mL/min/1.73 m2).

After 41 months of follow-up, they observed each incremental total daily protein intake of 0.1 g/kg ideal body weight was associated with an additional annual eGFRcysC decline of -0.12 mL/min/1.73 m2. Results were similar for both animal and plant protein.

foods high in protein 
Patients who had higher protein intakes experienced a more rapid decline in kidney function.
Source: Adobe Stock

Furthermore, patients who had a daily total protein intake of at least 1.20 g/kg ideal body weight experienced a twofold faster annual eGFRcysC decline compared with those who consumed less than 80 g/kg (-1.60 mL/min/m2 vs. -0.84 mL/min/1.73 m2).

“This is the first and largest cohort of older state-of-the-art drug-treated post-MI patients showing that high-protein intake is associated with accelerated kidney function decline,” the researchers wrote. “Our findings are in line with the current KDIGO guidelines recommending to limit daily total protein intake to [less than] 1.30 g/kg body weight in adults at risk for CKD, and to restrict protein intake to 0.60-0.80 g/kg/day in patients with diabetes or eGFR [of less than] 30 mL/min/1.73 m2.” – by Melissa J. Webb

Disclosures: Esmeijer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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