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Estimation of daily protein intake based on spot urine urea nitrogen concentration in chronic kidney disease patients

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Abstract

Background

Determination of daily protein intake in the management of chronic kidney disease (CKD) requires precision. Inaccuracies in recording dietary intake occur, and estimation from total urea excretion presents hurdles owing to the difficulty of collecting whole urine for 24 h. Spot urine has been used for measuring daily sodium intake and urinary protein excretion.

Methods

In this cross-sectional study, we investigated whether urea nitrogen (UN) concentration in spot urine can be used to predict daily protein intake instead of the 24-h urine collection in 193 Japanese CKD patients (Stages G1–G5). After patient randomization into 2 datasets for the development and validation of models, bootstrapping was used to develop protein intake estimation models.

Results

The parameters for the candidate multivariate regression models were male gender, age, body mass index (BMI), diabetes mellitus, dyslipidemia, proteinuria, estimated glomerular filtration rate, serum albumin level, spot urinary UN and creatinine level, and spot urinary UN/creatinine levels. The final model contained BMI and spot urinary UN level. The final model was selected because of the higher correlation between the predicted and measured protein intakes r = 0.558 (95 % confidence interval 0.400, 0.683), and the smaller distribution of the difference between the measured and predicted protein intakes than those of the other models.

Conclusion

The results suggest that UN concentration in spot urine may be used to estimate daily protein intake and that a prediction formula would be useful for nutritional control in CKD patients.

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Acknowledgments

The authors thank Dr. Edward Barroga, Associate Professor and Senior Medical Editor of Tokyo Medical University for editing the manuscript. Part of this study was presented at the 55th Congress of the Japanese Society of Nephrology (2012, Yokohama, Japan), and at the 44th Annual Congress of the American Society of Nephrology (2012, San Diego, USA).

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Authors and Affiliations

  1. Clinical Laboratory, Tokyo Women’s Medical University, Tokyo, Japan

    Hiroko Kanno & Asako Sato

  2. Department of Nephrology, Tokyo Kyosai Hospital, Tokyo, Japan

    Eiichiro Kanda

  3. Department of Clinical Nutrition and Dietetics, Kagawa Nutrition University, Sakado, Japan

    Kaori Sakamoto

  4. Department of Nephrology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan

    Yoshihiko Kanno

Authors
  1. Hiroko Kanno
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  2. Eiichiro Kanda
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  3. Asako Sato
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  4. Kaori Sakamoto
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  5. Yoshihiko Kanno
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Corresponding author

Correspondence to Yoshihiko Kanno.

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None declared.

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Kanno, H., Kanda, E., Sato, A. et al. Estimation of daily protein intake based on spot urine urea nitrogen concentration in chronic kidney disease patients. Clin Exp Nephrol 20, 258–264 (2016). https://doi.org/10.1007/s10157-015-1164-5

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  • DOI: https://doi.org/10.1007/s10157-015-1164-5

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