USE OF 24 HOURS URINE UREA NITROGEN (UUN) AND URINARY SODIUM WITH PROTEIN AND SALT CONSUMPTION IN THREE DIFFERENT DIETARY PROTEIN INTAKE GROUPS OF CHRONIC KIDNEY DISEASE PATIENTS

Introduction:

Low protein and low salt consumption is crucial in treating advanced uremia and hypertension in chronic kidney disease (CKD) patients. Patient’s adherence towards dietary consumption of protein and sodium were assessed longitudinally with UUN and urinary sodium levels in three different protein intervention groups.

Methods:

This one year prospective randomized controlled study included patients of CKD 3 to 5 (ND) of age 18 to 60 years who were screened from Nephrology OPD during November 2022 to November 2023. Demographic profile, socio- economic status, dietary habits were recorded. 24hr urinary sodium, UNN and eGFR by CKD-EPI were measured at baseline, 6th month and one year. Patients were randomized into 3 groups: Normal protein (NP) (0.8-1.0g/kg/day), low protein (LP) (0.6g/kg/day) and very low protein supplemented (VLP) with Ketoanalogues (0.3g/kg/day) as a method of dietary intervention. All were counseled to a prescribed diet based on their eGFR level. Their dietary nutrient analysis was done by Diet Cal version 10.0 software. Protein and sodium intake was calculated by using UUN(g)+{0.031*weight(kg)}*6.25 and Kawasaki method respectively. Repeated measure ANOVA showed trend of dietary protein and sodium intake were similar with UUN and Urinary Sodium in all three groups at three different time interval. Further, association of blood pressure and eGFR with sodium intake and disease progression was also studied.

Results:

A total 322 CKD subjects of stage 3(111), Stage 4(105), Stage 5(106) were randomized in to three groups NP-43, LP-156, VLP-123 respectively. Demography as, male 196(60.8%), mean age 45 years, BMI 23.8kg/m2, 100% sedentary lifestyle, Diabetic 81(25.1%) and hypertension 265(82.3%) were present. Over one year, UUN decreased significantly in all three diet groups which correspond to dietary protein intake except in was in NP group; urine sodium was decreased in all groups which correspond to LP and VLP groups only (Table 1). In all three CKD stages UNN has in a decreasing trend (Fig 1). At one year correlation between dietary and urinary sodium were NP (p-0.000,r-0.576), LP (p-0.000,r-0.442) and VLP (p-0.001,r-0.283) and dietary protein between UUN were NP(p-0.575,r-0.109), LP(p-0.005,r-0.330) and VLP(p-0.081,r-0.188) respectively. There was improvement in eGFR and BP over one year.

Conclusions:

Patients adherence to the prescribed diet can be assessed by regular UNN and urinary sodium monitoring which will stabilize the hypertension and CKD progression.

I have potential conflict of interest to disclose.
Funded by ICMR & Supported by AUBADE HEALTHCARE PVT LTD DELHI.

I did not use generative AI and AI-assisted technologies in the writing process.