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Development and validation of a simple equation to evaluate dietary protein intake using the blood urea nitrogen/serum creatinine ratio in patients with stage 3 chronic kidney disease

  • Nephrology - Original Paper
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Abstract

Purpose

The aim of this research was to develop a simple equation to evaluate dietary protein intake (DPI) in patients with stage 3 chronic kidney disease (CKD) using the blood urea nitrogen (BUN)/serum creatinine (SCr) ratio (BUN/SCr).

Methods

In a prospective cohort of 136 inpatients with stage 3 CKD from 2 centres, the estimated dietary protein intake (DPI) was calculated using Maroni’s formula after the patients implemented a 7 day protein-restricted diet. We developed estimation equations based on BUN/SCr and the spot urinary urea nitrogen (UUN)/urinary creatinine (UCr) ratio (UUN/UCr) in combination with sex and body mass index (BMI). These equations were then internally and externally validated.

Results

The following candidate parameters were derived from univariate regression analysis for 5 established models: sex, BMI, BUN/SCr, UUN and UUN/UCr. Sex and BMI were included in all models after variable evaluation using multiple regression analysis. UUN, UUN/UCr and BUN/SCr were included in model 3, model 4 and model 5, respectively. Both internal and external validation indicated that model 5 resulted in the lowest values for bias and root mean square error and the highest P30 compared with model 3 and model 4. Therefore, the model 5 equation, DPI =  − 5.18 (− 14.49 if the patient is female) + 1.89 × BMI + 1.38 × BUN/SCr, was selected because of the higher correlation (r = 0.498) between the estimated DPI and predicted DPI.

Conclusion

The DPI equation developed using BUN/SCr, sex and BMI may be used to estimate protein intake for patients with stage 3 CKD.

Trial registration

Chinese Clinical Trial Registry Center (ChiCTR-ROC-17011363). Registered on 11 May 2017, Retrospectively registered, http://www.chictr.org.cn/index.aspx.

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Acknowledgements

This study was supported by grants from the High-level Hospital Construction Project of Guangdong Province (DFJH201908), National Natural Science Foundation of China (81470974).

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Author notes

  1. Yanhui Wang, Zujiao Chen and Jing Li contributed equally to this work.

Authors and Affiliations

  1. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China

    Yanhui Wang, Zujiao Chen, Jing Li, Yifan Zhang, Tiantian Liang, Hokhim Yau, Shaogui Zhang & Wenjian Wang

  2. Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 106 Zhongshan Er Road, Main Building, Room 1436, 510080, GD, China

    Yanhui Wang, Zujiao Chen, Jing Li, Jianteng Xie, Sheng Li, Yifan Zhang, Tiantian Liang, Hokhim Yau, Chunfang Qi, Shaogui Zhang & Wenjian Wang

  3. Division of Clinical Nutrition, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China

    Zhen Li & Duan Wang

  4. School of Medicine, South China University of Technology, Guangzhou, 510006, China

    Jianteng Xie, Sheng Li, Chunfang Qi & Wenjian Wang

  5. Shantou University Medical College, Shantou, 515041, China

    Qiuling Li, Shaochun Lin & Wenjian Wang

  6. Division of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China

    Yanhui Wang

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  1. Yanhui Wang
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Corresponding author

Correspondence to Wenjian Wang.

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Conflict of interest

The authors declare that they have no competing interests.

Human and animal rights

The study protocol has been approved by the medical ethics committee of Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences and the First Affiliated Hospital of Wenzhou Medical University and conducted according to the principles of the Declaration of Helsinki. Informed consent was obtained from every patient as specified in the recommendations of the International Committee of Medical Journal Editors (ICMJE).

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The authors acknowledge that the paper was published as a preprint at https://doi.org/10.21203/rs.3.rs-112166/v1.

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Wang, Y., Chen, Z., Li, J. et al. Development and validation of a simple equation to evaluate dietary protein intake using the blood urea nitrogen/serum creatinine ratio in patients with stage 3 chronic kidney disease. Int Urol Nephrol 54, 1279–1286 (2022). https://doi.org/10.1007/s11255-021-02993-6

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  • DOI: https://doi.org/10.1007/s11255-021-02993-6

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