The Relationship Between Dietary Protein Intake Restriction and Mortality Risk in Stage V Chronic Kidney Disease Patients With Haemodialysis : Literature Review
DOI:
https://doi.org/10.55227/ijhet.v3i5.241Keywords:
Chronic Kidney Disease, Haemodialysis, Protein IntakeAbstract
Chronic Kidney Disease (CKD) is a condition in which kidney function progressively declines and irreversibly diminishes so that the kidneys are unable to maintain metabolic, fluid and electrolyte balance resulting in uremia and azotemia. One of the kidney replacement therapies in stage 5 of CKD is by hemodialysis procedure. There are 5 – 8 g/dialysis amino acids losses during the hemodialysis (HD) procedured , if protein loss is not replaced with adequate dietary protein intake it will certainly affect malnutrition which can increase the risk of mortality. Inadequate protein intake is associated with protein energy wasting. However, the associated impact of protein intake on mortality remains unclear. Literature review was conducted to identify the effect of protein intake restriction on mortality risk in CKD patients undergoing hemodialysis. Articles were searched through NCBI (The National Center for Biotechnology Information), PubMed/Medline and Science Direct. Prisma Method was used to describe the process of selecting journals in a structured manner so that valid journals are obtained for analysis in this study. The results showed that appropriate management of protein intake for patients undergoing haemodialysis is necessary to prevent malnutrition, high protein intake can increase phosphorus and potassium levels and risk metabolic acidosis, and extensive restriction can lead to malnutrition and death with the hazard ratio 1.33. It is recommended that protein intake in CKD patients undergoing hemodialysis be in the range of 1.0 - 1.2 g/kg/day.
Downloads
References
Aryaie, M., Sharifi, H., Saber, A., Nazemipour, M., & Mansournia, M.A. (2021). Longitudinal Causal Effects of Normalized Protein Catabolic Rate on All-Cause Mortality in Patients With End-Stage Renal Disease: Adjusting for Time-Varying Confounders Using the G-Estimation Method. American Journal of Epidemiology, 190(6), 1133–1141.https://doi.org/10.1093/aje/kwaa281
Bellizzi, V., Chiodini, P., Cupisti, A., Viola, B.F., Pezzotta, M., de Nicola, L., Minutolo, R., Barsotti, G., Piccoli, G.B., & di Iorio, B. (2015). Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrology Dialysis Transplantation, 30(1), 71–77.https://doi.org/10.1093/ndt/gfu251
Bellizzi, V., Signoriello, S., Minutolo, R., di Iorio, B., Nazzaro, P., Garofalo, C., Calella, P., Chiodini, P., & de Nicola, L. (2022) . No additional benefit of prescribing a very low-protein diet in patients with advanced chronic kidney disease under regular nephrology care: a pragmatic, randomized, controlled trial. The American Journal of Clinical Nutrition, 115(5), 1404–1417.https://doi.org/10.1093/ajcn/nqab417
Darzi, M., Rouhani, M. H., & Keshavarz, S.-A. (2023). The association between plant and animal protein intake and quality of life in patients undergoing hemodialysis. Frontiers in Nutrition, 10. https://doi.org/10.3389/fnut.2023.1219976
Gurung, R. (2024). Effects of Dietary Protein Restriction on Nutritional Status of Hemodialysis Patients. Journal of Nursing Research,Patient Safety and Practise, 41, 40–56. https://doi.org/10.55529/jnrpsp.41.40.56
Hasegawa, J., Kimachi, M., Kurita, N., Kanda, E., Wakai, S., & Nitta, K. (2020). The Normalized Protein Catabolic Rate and Mortality Risk of Patients on Hemodialysis by Frailty Status: The Japanese Dialysis Outcomes and Practice Pattern Study. Journal of Renal Nutrition, 30(6), 535–539. https://doi.org/10.1053/j.jrn.2019.12.005
He, Y., Lu, Y., Yang, S., Li, Y., Yang, Y., Chen, J., Huang, Y., Lin, Z., Li, Y., Kong, Y., Zhao, Y., Wan, Q., Wang, Q., Huang, S., Liu, Y., Liu, A., Liu, F., Hou, F.F., Qin, X., & Liang, M. ( 2021). Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study. American Journal of Kidney Diseases, 78(5), 649-657.e1.https://doi.org/10.1053/j.ajkd.2021.03.023
Hendriks, F.K., Kooman, J.P., & van Loon, L.J.C. (2021). Dietary protein interventions to improve nutritional status in end-stage renal disease patients undergoing hemodialysis. Current Opinion in Clinical Nutrition & Metabolic Care, 24(1), 79–87. https://doi.org/10.1097/MCO.0000000000000703
Hendriks, FK, Smeets, JSJ, Broers, NJH, van Kranenburg, JMX, van der Sande, FM, Kooman, JP, & van Loon, LJC (2020). End-Stage Renal Disease Patients Lose a Substantial Amount of Amino Acids during Hemodialysis. The Journal of Nutrition, 150(5), 1160–1166.https://doi.org/10.1093/jn/nxaa010
Hidayangsih, PS, Tjandrarini, DH, Sukoco, NEW, Sitorus, N., Dharmayanti, I., & Ahmadi, F. (2023). Chronic kidney disease in Indonesia: evidence from a national health survey. Osong Public Health and Research Perspectives, 14(1), 23–30.https://doi.org/10.24171/j.phrp.2022.0290
Ikizler, T. A., Burrowes, J. D., Byham-Gray, L. D., Campbell, K. L., Carrero, J.-J., Chan, W., Fouque, D., Friedman, A. N., Ghaddar, S., Goldstein-Fuchs, D. J., Kaysen, G. A., Kopple, J. D., Teta, D., Yee-Moon Wang, A., & Cuppari, L. (2020). KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. American Journal of Kidney Diseases, 76(3), S1–S107. https://doi.org/10.1053/j.ajkd.2020.05.006
Indonesian Nephrology Association. 2013. Nutrition Consensus on Chronic Kidney Disease. Jakarta. Indonesian Nephrology Association
Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 12(1), 7–11.https://doi.org/10.1016/j.kisu.2021.11.003
Lee, J.E., Kim, H.-J., Lee, M.J., Kwon, Y.E., Kyung, M.-S., Park, J.-T., Lee, J.P., Kim, S.-H., Kim, J.-H., Oh, H.J., & Ryu, D.-R. (2020). Comparison of dietary intake patterns in hemodialysis patients by nutritional status: A cross-sectional analysis. Kidney Research and Clinical Practice, 39(2), 202–212.https://doi.org/10.23876/j.krcp.20.037
Levin, A., Ahmed, S.B., Carrero, J.J., Foster, B., Francis, A., Hall, R.K., Herrington, W.G., Hill, G., Inker, L.A., Kazancıoğlu, R., Lamb, E., Lin, P., Madero, M., McIntyre, N., Morrow, K., Roberts, G., Sabanayagam, D., Schaeffner, E., Shlipak, M., … Stevens, P. E. (2024). Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. Kidney International, 105(4), 684–701.https://doi.org/10.1016/j.kint.2023.10.016
Li, J., Hou, G., Sun, X., Chen, A., & Chai, Y. (2020). A Low-Cost, Intradialytic, Protein-Rich Meal Improves the Nutritional Status in Chinese Hemodialysis Patients. Journal of Renal Nutrition, 30(2), e27–e34.https://doi.org/10.1053/j.jrn.2019.03.084
Minister of Health of the Republic of Indonesia. 2023. National Guidelines for Medical Services for the Management of Chronic Kidney Disease. Jakarta. Minister of Health of the Republic of Indonesia.
Ravel, V.A., Molnar, M.Z., Streja, E., Kim, J.C., Victoroff, A., Jing, J., Benner, D., Norris, K.C., Kovesdy, C.P., Kopple, J.D., & Kalantar-Zadeh, K . (2013). Low Protein Nitrogen Appearance as a Surrogate of Low Dietary Protein Intake Is Associated with Higher All-Cause Mortality in Maintenance Hemodialysis Patients1–3. The Journal of Nutrition, 143(7), 1084–1092.https://doi.org/10.3945/jn.112.169722
Sahathevan, S., Khor, B.-H., Ng, H.-M., Gafor, AHA, Mat Daud, ZA, Mafra, D., & Karupaiah, T. (2020). Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review. Nutrients, 12(10). https://doi.org/10.3390/nu12103147
Salamah, S., Post, A., Alkaff, F. F., van Vliet, I. M. Y., Ipema, K. J. R., van der Veen, Y., Doorenbos, C. S. E., Corpeleijn, E., Navis, G., Franssen, C. F. M., & Bakker, S. J. L. (2024). Association between objectively measured protein intake and muscle status, health-related quality of life, and mortality in hemodialysis patients. Clinical Nutrition ESPEN, 63, 787–795. https://doi.org/10.1016/j.clnesp.2024.08.011
Sarav, M., & Kovesdy, C. P. (2018). Protein Energy Wasting in Hemodialysis Patients. Clinical Journal of the American Society of Nephrology, 13(10), 1558–1560. https://doi.org/10.2215/CJN.02150218
Schaminee, DPE, Kosters, C.M., Verbeek, FHO, Atsma, F., & van den Berg, MGA (2021). Protein and energy intake: Comparison of two food services in patients during hemodialysis treatment. Nutrition, 90, 111260.https://doi.org/10.1016/j.nut.2021.111260
Sulistyowati Y, Yuniritha E. (2015). Nutrient Metabolism. Yogyakarta. Trans Medika.
Tan, R., Liang, D., Liu, Y., Zhong, X., Zhang, D., & Ma, J. (2019). Bioelectrical Impedance Analysis–Derived Phase Angle Predicts Protein–Energy Wasting in Maintenance Hemodialysis Patients. Journal of Renal Nutrition, 29(4), 295–301. https://doi.org/10.1053/j.jrn.2018.09.001
Wang L, Xu X, Zhang M, et al. (2023). Prevalence of Chronic Kidney Disease in China: Results From the Sixth China Chronic Disease and Risk Factor Surveillance. JAMA Intern Med. ;183(4):298–310. doi:10.1001/jamainternmed.2022.6817
Wang, J., Luo, P., Yang, Y., Lin, Z., Wen, Z., Li, Y., Huang, Y., Yang, S., Lu, Y., Kong, Y., Zhao, Y., Wan, Q., Wang, Q., Huang, S., Liu, Y., Liu, A., Liu, F., Hou, F., Qin, X., & Liang, M. (2022). Dietary protein intake and the risk of all-cause and cardiovascular mortality in maintenance hemodialysis patients: A multicenter, prospective cohort study. Nutrition, 95, 111564.https://doi.org/10.1016/j.nut.2021.111564
Wiji RN, Fitri I. (2021). Nutrition and Efforts to Form Nutrition-Aware Families. Yogyakarta. Gosyen Publishing.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 M. Agung Prasetya Adnyana Yoga, Reni Zuraida, Dian Isti Angraini

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.