The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease - PubMed (original) (raw)

The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease

Ranjani N Moorthi et al. Am J Nephrol. 2014.

Abstract

Background: Chronic Kidney Disease (CKD) is associated with alterations in phosphorus excretion, and increases in fibroblast growth factor (FGF23) and parathyroid hormone (PTH). Plant protein-based phytate-bound phosphorus, is less bioavailable than that from animal sources. Our one-week study that was conducted previously showed that a nearly 100% plant protein-based diet benefits mineral metabolism in CKD; however, this diet may not be acceptable to patients. Here we hypothesize that a diet containing 70% protein from plants has similar efficacy and is tolerated by CKD patients.

Methods: Thirteen subjects with CKD 3-4 received an omnivorous diet containing 70% protein from plants for 4 weeks. The primary outcome was change in 24 h urine phosphorus. Secondary outcomes were changes in serum phosphorus, FGF23, PTH, urine sodium excretion, grip strength and fat free mass. Repeated measures analysis of variance (ANOVA) was used to test differences in parameters over the 4 weeks.

Results: Mean age of subjects was 54.8 years. Median eGFR was 26 (IQR 14.7) ml/min/1.73 m(2). Over the 4-week period, urine phosphorus significantly decreased by 215 ± 232 mg/day (p < 0.001). No significant changes in serum FGF23, phosphorus or PTH were noted. Urine sodium and titratable acid decreased significantly on the diet. Hand grip strength and fat-free mass did not change. There were two hyperkalemia events both 5.8 mEq/l, corrected by food substitutions. No other adverse events were observed.

Conclusions: A 70% plant protein diet is safe, tolerated, and efficacious in lowering urine phosphorus excretion and may be an alternative to phosphate binders.

© 2015 S. Karger AG, Basel.

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Conflict of interest statement

Conflicts of Interest: None of the authors declare any conflicts of interest.

Figures

Figure 1

Figure 1

Overview of Study, with key study procedures on the right, and their timing represented by an X. There were a total of 7 visits in the 0 to 4 week “study diet” period for pick-up of prepared foods, including the 3 visits with end point assessments.

Figure 2

Figure 2

Twenty-four hour Urine P excretion for each of the 13 subjects. There are 3 bars per subject, depicting the pre-study urine P excretion, on 2 weeks of study diet and on 4 weeks of study diet.

Figure 3

Figure 3

Changes in FGF23 with diet in all subjects (A) and with outlier excluded (B). Each line represents one subject. The outlier excluded had a FGF23>500Ru/ml

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