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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Uremia is a life-threatening condition of end-stage kidney disease, characterized by elevated serum urea nitrogen level (UN) and other uremic toxins. While previous studies have shown the association between greater protein intake and higher serum UN, few studies have investigated whether dietary fiber intake modifies the association in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). We aimed to examine the association between protein intake and UN in patients with NDD-CKD and the presence of interaction of the association by dietary fiber intake.
A total of 274 patients (median age 72 years; 34% women) at three hospitals were eligible. Food and nutrient intake were estimated using a validated diet history questionnaire. Blood tests were performed during the outpatient visit or hospital admission. We stratified patients into three groups by tertile cutpoints of fiber intake and compared food group intake between the three groups. We examined the association between protein intake and UN by multiple linear regression, adjusted for potential confounders including age, sex, estimated glomerular filtration rate (eGFR), body mass index (BMI), and use of loop diuretics or thiazides. We repeated the regression analysis in three tertile groups of fiber intake. UN was natural log-transformed due to its skewed distribution. We also repeated the analyses after replacing UN with a ratio of UN to serum creatinine (UN/CRE).
The median (interquartile range) eGFR, UN, and UN/CRE were 31.2 (21.7–42.4) mL/min/1.73m2, 24.0 (18.8–37.4) mg/dL, and 15.3 (12.6–18.1), respectively. The median protein and fiber intake were 38.3 g/1000 kcal/day and 6.2 g/1000 kcal/day, respectively. Patients with higher fiber intake had greater intakes of potatoes, pulses, green/yellow vegetables, other vegetables, fruits, and fish, as well as lower intakes of grains, compared to those with lower fiber intake. In all patients, protein intake was positively associated with UN (regression coefficient (β) = 0.060, 95% confidence interval (CI): 0.018 to 0.101, for every 10 g/1000 kcal/day increase in protein intake) and UN/CRE (β = 0.071, 95% CI: 0.030 to 0.113). After stratification by tertile groups of fiber, the association between protein intake and UN persisted in groups with low and medium fiber intake (Tertile 1: β = 0.121, 95% CI: 0.033 to 0.210; Tertile 2: β = 0.101, 95% CI: 0.026 to 0.175), while the association was no longer significant in the high fiber group (Tertile 3: β = 0.021, 95% CI: -0.052 to 0.094). Similar trends were observed for UN/CRE.
Protein intake was positively associated with UN and UN/CRE in patients with NDD-CKD. The association was attenuated in patients with higher fiber intake, who had higher intakes of fruits, vegetables, and fish. Our findings suggest the possibility that UN may not increase much even when protein intake is increased as long as fiber intake is adequate. Further studies are warranted to examine the effect of fiber on the association between protein intake and renal prognosis.
