Metabolic Effects of Dietary Protein in Chronic Renal Failure

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Abstract
To study the effects of dietary protein in chronic renal failure, 6 such patients were placed on control, high (1.5 or 2.0 gm/kg) and low (15 gm) protein diets for 1 or 2 weeks each. Compared to control values, high protein reduced glomerular filtration rate by 14.9% and renal plasma flow by 13.8%; low protein increased these by 15.0 and 10.4%, respectively. Blood urea N rose by 78.2% on the high and fell 58.2% on the low intake; CO2 content was reduced 7.3% and increased 14.3% on the high and low diets respectively. Urine titratable acidity increased 188% with protein loading. Plasma volume increased during both study periods, but more on the high; extracellular fluid volume increased with the high and fell with the low diet. Studies revealed that 22.6% of P intake of the control period was excreted in the urine; 21.3% of that of the high diet; and 76.8% of the low diet. Corresponding values for S excretion were 24.2, 28.9 and 49.5%. With protein restriction, serum sodium increased while K decreased slightly. Decreased renal Na conservation and K excretion during the low diet indicate that hypokalemia may develop on this diet. Serum Mg and proteins, but not Ca, declined on the low diet. Improvement in renal function with a low protein diet is attributed to more complete intestinal absorption of Na as azotemia was corrected. This study confirms the clinical usefulness of the low protein diet.

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