Kidney Week

Abstract: TH-PO782

Restriction of Protein: Leveraging the Risk of Sarcopenia and the Progression of CKD in Older Patients

Session Information

• Voices, Choices, and Outcomes of Older Adults with CKD
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

• 1200 Geriatric Nephrology

Authors

• Innecchi, Mariana Leister Rocha, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Sao Paulo, São Paulo, Brazil

Mariana Leister Rocha Innecchi,

• Avesani, Carla Maria, Karolinska Institutet, Stockholm, Stockholm, Sweden

Carla Maria Avesani,

• Coelho, Venceslau Antonio, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Sao Paulo, São Paulo, Brazil

Venceslau Antonio Coelho,

• Lauar, Julia, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Sao Paulo, São Paulo, Brazil

Julia Lauar,

• Costa, Tiago Emanuel, Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Sao Paulo, São Paulo, Brazil

Tiago Emanuel Costa,

• Moyses, Rosa M.A., Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Sao Paulo, São Paulo, Brazil

Rosa M.A. Moyses,

• Elias, Rosilene M., Universidade de Sao Paulo Instituto de Ciencias Biomedicas, Sao Paulo, São Paulo, Brazil

Rosilene M. Elias,

Background

Most guidelines recommend a restriction in protein intake to slow the progression of CKD. However, older patients are at high risk for sarcopenia which can be worsened with low energy and protein intake. Since older patients are often excluded from clinical trials, there is a scarcity of data to support this recommendation in this population. We aimed to evaluate nutritional status and sarcopenia in older patients with CKD.

Methods

This is a cross-sectional analysis of older patients (>70 yr) with stage 4 and 5 CKD on conservative management. We assessed biochemical data, 24-hour dietary recall, skinfold thicknesses, and other anthropometric measurements. Sarcopenia was assessed by the SARC-F and SARCF-Calf circumference (SARCF-CC) questionnaires (higher scores indicate higher risk for sarcopenia).

Results

We included 54 patients (81 ± 7 yr, 59.3% men, body mass index 25.5 ± 4.4 kg/m², 61.1% diabetes, eGFR 20.1 ± 6.9 ml/min, 20.4% below recommended weight). Patients were divided in 3 groups: 70-80, 81-90 and > 90 yr. (Table 1). Body mass index, CC and percentage of body fat were lower in those >90yr, for similar renal function. SARCF was similar among groups (p=0.348) and SARCF-CC was higher among patients >90 yr (p=0.031). Adherence to ingesting protein intake 0.6-0.8g/Kg was followed by 26.9%, 21.1% and 11.1 % of patients in groups 70-80, 80-90 and > 90yr, respectively (p=0.065).

Conclusion

This analysis suggests that the older patients, particularly those > 90yr, are more susceptible to malnutrition and sarcopenia. Therefore, protein-restricted diets must be considered with caution according to the patients clinical and nutritional condition to avoid further worsening in the nutritional status.