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Protein restriction and chronic kidney disease
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Introdução: Há evidência experimental sugestiva de que a restrição proteica pode melhorar a hiperfiltração glomerular e preservar a taxa de filtração glomerular (TFG), mas nem todos os estudos clínicos demonstram efeitos benéficos consistentes em todos os pacientes com doença renal crónica (DRC), questionando a sua segurança sobre a diminuição do consumo energético e o risco de malnutrição. Os autores pretendem realizar uma revisão abrangente da eficácia e segurança da restrição proteica na progressão da DRC. Métodos: Esta revisão narrativa inclui artigos publicados no PubMed, entre 2000 e 2023, sobre o efeito da restrição proteica na progressão da DRC em pacientes com DRC nos estágios 3, 4 e 5 sem diálise. A análise do efeito da progressão da DRC (declínio da TFG ou ocorrência de insuficiência renal terminal (IRT)) foi definida de acordo com cada estudo. A ingestão elevada de proteínas na dieta leva ao aumento da pressão intraglomerular e à hiperfiltração glomerular, que a longo prazo será prejudicial para os rins. Assim, a restrição proteica em pacientes com DRC é uma medida recomendada pelas recentes diretrizes internacionais KDOQI, e vários estudos têm demonstrado efeitos favoráveis na diminuição do declínio da TFG ou nastaxas de ocorrência de IRT. Assim sendo, parece aconselhável seguir uma dieta com restrição proteica bem estruturada em pacientes com DRC entre os estágios 3, 4 e 5 (sem diálise) para retardar a progressão da DRC. A preocupação com a ocorrência de malnutrição nestes doentes não foi comprovada. Concluindo que uma dieta com restrição proteica precisa de uma ingestão energético calórica adequada concomitante, para manter a segurança destas medidas.
Background: Experimental evidence suggests that protein restriction can ameliorate glomerular hyperfiltration and preserve glomerular filtration rate (GFR), but not all clinical studies demonstrate consistent beneficial effects in all patients with chronic kidney disease (CKD), questioning its safety about diminished energy intake and risk of malnutrition. The authors aim to perform a comprehensive review of the effectiveness and safety of protein restriction on CKD progression. Methods: The present work includes articles published on PubMed from 2000 up to 2023, analyzing the effect of protein restriction on CKD progression among patients with CKD stages 3, 4 and 5, not on dialysis. The analyzed outcome of CKD progression (GFR decline or end-stage renal disease (ESRD) occurrence) was defined accordingly in each study. High dietary protein intake leads to increased intraglomerular pressure and glomerular hyperfiltration, which in the long-term will be harmful for the kidneys. Thus, lowering protein intake in CKD patients is a recommended measure by the recent international guidelines by KDOQI and several studies showed favorable effects on delaying GFR decline or ESRD occurrence rates. Therefore, it seems reasonable to follow a well designed protein-restricted diet on CKD patients between stages 3, 4 and 5 (not on dialysis) to delay progression of CKD. In these patients, the concern with malnutrition was not proved. Concluding that restricting protein in diet needs to be balanced with a concomitant adequate energy intake to sustain dietary management safety
Background: Experimental evidence suggests that protein restriction can ameliorate glomerular hyperfiltration and preserve glomerular filtration rate (GFR), but not all clinical studies demonstrate consistent beneficial effects in all patients with chronic kidney disease (CKD), questioning its safety about diminished energy intake and risk of malnutrition. The authors aim to perform a comprehensive review of the effectiveness and safety of protein restriction on CKD progression. Methods: The present work includes articles published on PubMed from 2000 up to 2023, analyzing the effect of protein restriction on CKD progression among patients with CKD stages 3, 4 and 5, not on dialysis. The analyzed outcome of CKD progression (GFR decline or end-stage renal disease (ESRD) occurrence) was defined accordingly in each study. High dietary protein intake leads to increased intraglomerular pressure and glomerular hyperfiltration, which in the long-term will be harmful for the kidneys. Thus, lowering protein intake in CKD patients is a recommended measure by the recent international guidelines by KDOQI and several studies showed favorable effects on delaying GFR decline or ESRD occurrence rates. Therefore, it seems reasonable to follow a well designed protein-restricted diet on CKD patients between stages 3, 4 and 5 (not on dialysis) to delay progression of CKD. In these patients, the concern with malnutrition was not proved. Concluding that restricting protein in diet needs to be balanced with a concomitant adequate energy intake to sustain dietary management safety
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Doença renal crónica Restrição proteica Dietas hipoproteicas Ingestão proteica Nutrição Nefrologia