Protein Diet and Estimated Glomerular Filtration Rate

Supatra Lohsiriwat

Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

DOI: 10.4236/ojneph.2013.32016                

Abstract

Chronic kidney disease (CKD) is a common health problem worldwide. CKD staging or classification, together with patients’ prognosis and treatment plan depend on the patients’ kidney function which is assessed by measurement of glomerular filtration rate (GFR). Estimated GFR can be obtained using serum or plasma creatinine as a main variable in equations or formulae such as Cockcroft-Gault equation, MDRD equation (Modification of Diet in Renal Disease), the Schwartz and Counahan-Barratt formulae. These equations, though widely accepted, still have to be adjusted or validated among different groups of patients according to the variation in some factors such as race, diet, and genetic heterogenicity. Diet, especially the high protein load, can affect GFR representing the renal functional reserve. A high protein diet can cause an increase in GFR that lasts for many hours. Long-term consumption of vegetarian diet which is low in protein and contains only protein from plant sources can cause a low baseline GFR while the renal functional reserve is still preserved. This paper aims to remind of the role of protein diet effect on GFR measurement especially when assessing the renal function in vegetarians or individuals on long-term low-protein intake.

Keywords

Protein Diet; Glomerular Filtration Rate; eGFR; Vegetarian

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. Coresh, B. Astor, T. Greene, G. Eknoyan and A. Levey, “Prevalence of Chronic Kidney Disease and Decreased Kidney Function in the Adult US Population: Third National Health and Nutrition Examination Survey,” American Journal of Kidney Diseases, Vol. 41, No. 1, 2003, pp. 1-12. doi:10.1053/ajkd.2003.50007
[2]	R. C. Atkins, K. R. Polkinghorne, E. M. Briganti, J. E. Shaw, P. Z. Zimmet and S. J. Chadban, “Prevalence of Albuminuria in Australia. The Ausdiab Kidney Study,” Kidney International, Vol. 66, 2004, pp. S22-S24. doi:10.1111/j.1523-1755.2004.09206.x
[3]	B. Rutkowski and E. Krol, “Epidemiology of Chronic Kidney Disease in Central and Eastern Europe,” Blood Purification, Vol. 26, 2008, pp. 381-385. doi:10.1159/000137275
[4]	C. P. Wen, T. Y. Cheng, M. K. Tsai, et al., “All-Cause Mortality Attributable to Chronic Kidney Disease: A Prospective Cohort Study Based on 462,293 Adults in Taiwan,” Lancet, Vol. 371, No. 9631, 2008, pp. 2173-2182. doi:10.1016/S0140-6736(08)60952-6
[5]	T. Konta, Z. Hao, H. Abiko, et al., “Prevalence and Risk Factor Analysis of Microalbuminuria in Japanese General Population: The Takahata Study,” Kidney International, Vol. 70, 2006, pp. 751-756. doi:10.1038/sj.ki.5001504
[6]	L. Ong-Ajyooth, K. Vareesangthip, P. Khonputsa and W. Aekplakorn, “Prevalence of Chronic Kidney Disease in Thai Adults: A National Health Survey,” BMC Nephrology, Vol. 10, 2009, p. 35. doi:10.1186/1471-2369-10-35
[7]	“National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification,” American Journal of Kidney Diseases, Vol. 39, No. 5, 2002, pp. S1-266. doi:10.1016/S0272-6386(02)70054-1
[8]	D. J. Preiss, I. M. Godber, E. J. Lamb, R. N. Dalton and I. R. Gunn, “The Influence of a Cooked-Meat Meal on Estimated Glomerular Filtration Rate,” Annals of Clinical Biochemistry, Vol. 44, No. 1, 2007, pp. 35-42. doi:10.1258/000456307779595995
[9]	G. Manjunath, M. J. Sarnak and A. S. Levey, “Estimating the Glomerular Filtration Rate. Dos and Don’ts for Assessing Kidney Function,” Post-graduate Medicine, Vol. 110, No. 6, 2001, pp. 55-62.
[10]	P. B. Rehberg, “Studies on Kidney Function I. The Rate of Filtration and Reabsorption in the Human Kidney,” Biochemical Journal, Vol. 20, 1926, p. 447.
[11]	J. M. Hayman Jr., J. A. Halsted and L. E. Seyler, “A Comparison of the Creatinine and Urea Clearance Tests of Kidney Function,” JCI, Vol. 12, No. 5, 1933, pp. 861875. doi:10.1172/JCI100545
[12]	D. W. Cockcroft and M. H. Gault, “Prediction of Creatinine Clearance from Serum Creatinine,” Nephron, Vol. 16, No. 1, 1976, pp. 31-41. doi:10.1159/000180580
[13]	A. S. Levey, J. P. Bosch, J. B. Lewis, T. Greene, N. Rogers and D. Roth, “A More Accurate Method to Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation. Modification of Diet in Renal Disease Study Group,” Annals of Internal Medicine, Vol. 130, No. 6, 1999, pp. 461-470. doi:10.7326/0003-4819-130-6-199903160-00002
[14]	G. L. Schwartz and B. Gauthier, “A Simple Estimate of Glomerular Filtration Rate in Adolescent Boys,” The Journal of Pediatrics, Vol. 106, No. 3, 1985, pp. 522-526. doi:10.1016/S0022-3476(85)80697-1
[15]	R. Counahan, C. Chantler, S. Ghazali, B. Kirkwood, F. Rose and T. M. Barrett, “Estimation of Glomerular Filtration Rate from Plasma Creatinine Concentration in Children,” Archives of Disease in Childhood, Vol. 51, No. 11, 1976, pp. 875-878. doi:10.1136/adc.51.11.875
[16]	G. Manjunath, M. J. Sarnak and A. S. Levey, “Estimating the Glomerular Filtration Rate. Dos and Don’ts for Assessing Kidney Function,” Postgraduate Medicine, Vol. 110, No. 6, 2001, pp. 55-62.
[17]	M. H. Rosner and K. Bolton, “Core Curriculum in Nephrology. Renal Function Test,” American Journal of Kidney Diseases, Vol. 47, No. 1, 2006, pp. 174-183. doi:10.1053/j.ajkd.2005.08.038
[18]	R. Hirschberg, H. Rottka, D. von Herrath, A. Pauls and K. Schaefer, “Effect of an Acute Protein Load on the Creatinine Clearance in Healthy Vegetarian,” Klinische Wochenschrift, Vol. 63, No. 5, 1985, pp. 217-220. doi:10.1007/BF01731172
[19]	S. Lohsiriwat and M. Sriponyaskul, “Effect of High-Protein Diet on the Glomerular Filtration Rate in the Adult and the Elderly,” Siriraj Medical Journal, Vol. 51, 1999, pp. 21-26.
[20]	P. A. Kontessis, I. Bossinakou, L. Sarika, E. Iliopoulou, A. Papantiniou, R. Trevisan, D. Roussi, K. Stipsanelli, S. Grigorakis and A. Souvatzoglou, “Renal, Metabolic, and Hormonal Responses to Proteins of Different Origin in Normotensive, Nonproteinuric Type I Diabetic Patients,” Diabetic Care, Vol. 18, No. 9, 1995, p. 1233. doi:10.2337/diacare.18.9.1233
[21]	S. Lohsiriwat and S. Thophol, “Effects of Vegetable and Animal Protein Meals on Glomerular Filtration Rate,” The Nephrology Society of Thailand, Vol. 6, 2000, pp. 217-223.
[22]	J. P. Bosch, A. Saccaggi, A. Lauer, C. Ronco, M. Belledonne and S. Glabman, “Renal Functional Reserve in Humans. Effect of Protein Intake on Glomerular Filtration Rate,” The American Journal of Medicine, Vol. 75, No. 6, 1983, pp. 943-950. doi:10.1016/0002-9343(83)90873-2
[23]	S. Lohsiriwat and A. Buageaw, “Renal Functional Reserve in Lacto-Vegetarian Adolescents,” Siriraj Medical Journal, Vol. 54, 2002, pp. 217-223.
[24]	S. Barai, S. Gambhir, N. Prasad, R. K. Sharma, M. Ora, A. Kumar, A. Gupta, D. S. Parasar and B. Suneetha, “Levels of GFR and Protein-Induced Hyperfiltration in Kidney Donors: A Single Center Experience in India,” American Journal of Kidney Diseases, Vol. 51, No. 3, 2008, pp. 407-414. doi:10.1053/j.ajkd.2007.11.008
[25]	M. J. Wiseman, R. Hunt, A. Goodwin, J. L. Gross, H. Keen and G. C. Viberti, “Dietary Composition and Renal Function in Healthy Subjects,” Nephron, Vol. 46, No. 1, 1987, pp. 37-42. doi:10.1159/000184293