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Effect of Dietary Protein Intake on Serum Total CO₂ Concentration in Chronic Kidney Disease: Modification of Diet in Renal Disease Study Findings

F. John Gennari^*, Virginia L. Hood^*, Tom Greene, Xulei Wang, and Andrew S. Levey

^* University of Vermont College of Medicine, Burlington, Vermont; Cleveland Clinic Foundation, Cleveland, Ohio; and New England Medical Center, Boston, Massachusetts

Address correspondence to: Dr. F. John Gennari, Rehab 2319 UHC Campus, Fletcher Allen Health Care, Burlington, VT 05401. Phone: 802-847-2534; Fax: 802-847-8736; E-mail: f-john.gennari{at}uvm.edu

Metabolic acidosis is a feature of chronic kidney disease (CKD), but whether serum bicarbonate concentration is influenced by variations in dietary protein intake is unknown. For assessing the effect of diet, data that were collected in the Modification of Diet in Renal Disease study were used. In this study, patients with CKD were enrolled into a baseline period, then randomly assigned to follow either a low- or a usual-protein diet (study A, entry GFR 25 to 55 ml/min) or a low- or very low–protein diet, the latter supplemented with ketoanalogs of amino acids (study B, entry GFR 13 to 24 ml/min). Serum [total CO₂] and estimated protein intake (EPI) were assessed at entry (n = 1676) and again at 1 yr after randomization, controlling for changes in GFR and other key covariates (n = 723). At entry, serum [total CO₂] was inversely related to EPI (1.0 mEq/L lower mean serum [total CO₂]/g per kg body wt increase in protein intake/d; P = 0.009). In an intention-to-treat analysis, the reduction in mean EPI in the low-protein group as compared with the usual-protein group (0.41 g/kg body wt per d) was independently associated with a 0.9-mEq/L increase in serum [total CO₂], after adjustment for covariates (P < 0.001). No such effect was evident in study B, in which the very low–protein diet group received dietary supplements. Serum [total CO₂] is inversely correlated with dietary protein intake in patients with CKD. A reduction in protein intake results in an increase in serum [total CO₂].

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