The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease

Ranjani Moorthi, Cheryl L H Armstrong, Kevin Janda, Kristen Ponsler-Sipes, John R. Asplin, Sharon Moe

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Chronic Kidney Disease (CKD) is associated with alterations in phosphorus excretion, and increases in fibroblast growth factor (FGF23) and parathyroid hormone (PTH). Plant protein-based phytate-bound phosphorus, is less bioavailable than that from animal sources. Our one-week study that was conducted previously showed that a nearly 100% plant protein-based diet benefits mineral metabolism in CKD; however, this diet may not be acceptable to patients. Here we hypothesize that a diet containing 70% protein from plants has similar efficacy and is tolerated by CKD patients. Methods: Thirteen subjects with CKD 3-4 received an omnivorous diet containing 70% protein from plants for 4 weeks. The primary outcome was change in 24 h urine phosphorus. Secondary outcomes were changes in serum phosphorus, FGF23, PTH, urine sodium excretion, grip strength and fat free mass. Repeated measures analysis of variance (ANOVA) was used to test differences in parameters over the 4 weeks. Results: Mean age of subjects was 54.8 years. Median eGFR was 26 (IQR 14.7) ml/min/1.73 m2. Over the 4-week period, urine phosphorus significantly decreased by 215 ± 232 mg/day (p < 0.001). No significant changes in serum FGF23, phosphorus or PTH were noted. Urine sodium and titratable acid decreased significantly on the diet. Hand grip strength and fat-free mass did not change. There were two hyperkalemia events both 5.8 mEq/l, corrected by food substitutions. No other adverse events were observed. Conclusions: A 70% plant protein diet is safe, tolerated, and efficacious in lowering urine phosphorus excretion and may be an alternative to phosphate binders.

Original languageEnglish
Pages (from-to)582-591
Number of pages10
JournalAmerican Journal of Nephrology
Volume40
Issue number6
DOIs
StatePublished - Feb 24 2014

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Plant Proteins
Chronic Renal Insufficiency
Phosphorus
Minerals
Diet
Health
Urine
Hand Strength
Parathyroid Hormone
Sodium
Fats
Phytic Acid
Hyperkalemia
Fibroblast Growth Factors
Serum
Analysis of Variance
Phosphates
Food
Acids

Keywords

  • Mineral
  • Phosphorus
  • Phytate
  • Plant-based protein

ASJC Scopus subject areas

  • Nephrology

Cite this

The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease. / Moorthi, Ranjani; Armstrong, Cheryl L H; Janda, Kevin; Ponsler-Sipes, Kristen; Asplin, John R.; Moe, Sharon.

In: American Journal of Nephrology, Vol. 40, No. 6, 24.02.2014, p. 582-591.

Research output: Contribution to journalArticle

Moorthi, Ranjani ; Armstrong, Cheryl L H ; Janda, Kevin ; Ponsler-Sipes, Kristen ; Asplin, John R. ; Moe, Sharon. / The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease. In: American Journal of Nephrology. 2014 ; Vol. 40, No. 6. pp. 582-591.
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abstract = "Background: Chronic Kidney Disease (CKD) is associated with alterations in phosphorus excretion, and increases in fibroblast growth factor (FGF23) and parathyroid hormone (PTH). Plant protein-based phytate-bound phosphorus, is less bioavailable than that from animal sources. Our one-week study that was conducted previously showed that a nearly 100{\%} plant protein-based diet benefits mineral metabolism in CKD; however, this diet may not be acceptable to patients. Here we hypothesize that a diet containing 70{\%} protein from plants has similar efficacy and is tolerated by CKD patients. Methods: Thirteen subjects with CKD 3-4 received an omnivorous diet containing 70{\%} protein from plants for 4 weeks. The primary outcome was change in 24 h urine phosphorus. Secondary outcomes were changes in serum phosphorus, FGF23, PTH, urine sodium excretion, grip strength and fat free mass. Repeated measures analysis of variance (ANOVA) was used to test differences in parameters over the 4 weeks. Results: Mean age of subjects was 54.8 years. Median eGFR was 26 (IQR 14.7) ml/min/1.73 m2. Over the 4-week period, urine phosphorus significantly decreased by 215 ± 232 mg/day (p < 0.001). No significant changes in serum FGF23, phosphorus or PTH were noted. Urine sodium and titratable acid decreased significantly on the diet. Hand grip strength and fat-free mass did not change. There were two hyperkalemia events both 5.8 mEq/l, corrected by food substitutions. No other adverse events were observed. Conclusions: A 70{\%} plant protein diet is safe, tolerated, and efficacious in lowering urine phosphorus excretion and may be an alternative to phosphate binders.",
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