Physicians' Academy for Cardiovascular Education

Role of protein intake & phosphate levels

Slides (presentation) - Feb. 21, 2012

CKD & Nutrition: Role of protein intake & phosphate levels

Presentation prepared by
Denis Fouque
University of Lyon
France

Presented at PACE Renal Master Class in Madrid, February 17-18, 2012


View presentation


Current & future management of chronic kidney disease
The Protein-Phosphorus issue in CKD
Nutritional Intake
Nutritional profile during CKD
Cochrane systematic review
Nephroprotection
Reducing Protein intake
Proportionate reduction in protein intake and proteinuria
VLPD reduces Proteinuria better than LPD
Protein intake induces renal inflammation
Protein intake induces renal pathology
LPD reduces renal inflammation
Ketoacids reduces renal fibrosis
LPD – KA reduce renal matrix accumualation
Overexpression of KLF15 and renal inflammation
LPD restores renal KLF15 expression
The role of Klotho on vascular calcifications
Reduction in serum urea nitrogen
After 3 months at 0.3 g/kg/d + ketoanalogues
Optimal Protein Intake
Aminoacid oxidation after reducing protein intake
Urinary urea excretion (mmol/d)
Serum albumin in the MDRD study
Nutritional status after the start of dialysis
Nutritional intake after the start of Dialysis
Low protein diet and inflammation
Low protein diet and inflammation
Improvement in serum glucose and insulinemia (after OGT)
Improvement in insulin resistance
Phosphate and bone
Reduction in oral phosphate load
Fibroblast Growth Factor 23
FGF 23 and renal function
FGF 23, mortality and renal death
FGF 23: modulated by phosphate/protein intake
FGF 23: modulated by nutrients
Modulating phosphate/FGF23 by binders
Artery stifness / FGF23 / binders
J Renal Nutr 2011:21:285-294
Slide 46
Warning: Risk of low energy intake
Caveats to low protein diets
NephSAP September 2011
From Research to Patient...
The Urgent Need for Renal Dietitians
Summary
Conclusion
Backlog
Facteurs de variabilité de la phosphorémie
Observatoire 2008
Slide 58
Serum phosphate control over time

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