Causal path analyses of the association of protein intake with risk of mortality and graft failure in renal transplant recipients

Clinical Transplantation
M Yusof SaidStephan J L Bakker

Abstract

The effect of a low protein intake on survival in renal transplant recipients (RTR) is unknown. A low protein intake may increase risks of malnutrition, low muscle mass, and death. We aimed to study associations of protein intake with mortality and graft failure and to identify potential intermediate factors. Protein intake was estimated from 24-h urinary urea excretion (24-h UUE). Graft failure was defined as return to dialysis or retransplantation. We used Cox regression analyses to analyze associations with outcome and potential intermediate factors in the causal path. In 604 RTR, mean ± SD 24-h UUE was 380 ± 114 mmol/24-h. During median follow-up for 7.0 yr (interquartile range: 6.2-7.5 yr), 133 RTR died and 53 developed graft failure. In univariate analyses, 24-h UUE was associated with lower risk of mortality (HR [95% CI] = 0.80 [0.69-0.94]) and graft failure (HR [95% CI] = 0.72 [0.56-0.92]). These associations were independent of potential confounders. In causal path analyses, the association of 24-h UUE with mortality disappeared after adjustment for muscle mass. Low protein intake is associated with increased risk of mortality and graft failure in RTR. Causal path analyses reveal that the association with mortality is ...Continue Reading

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Citations

Mar 1, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·M Yusof SaidStephan J L Bakker
Aug 23, 2020·Nutrients·Antonio W Gomes NetoStephan J L Bakker
May 11, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Suzanne P StamVincent E de Meijer
Oct 20, 2020·Clinical Nutrition : Official Journal of the European Society of Parenteral and Enteral Nutrition·Adrian PostStephan J L Bakker
Dec 21, 2020·Clinical Nutrition : Official Journal of the European Society of Parenteral and Enteral Nutrition·K Boslooper-MeulenbeltGerjan J Navis
Jun 7, 2021·The American Journal of Clinical Nutrition·M Yusof SaidStephan Jl Bakker
Jun 18, 2021·Clinical Journal of the American Society of Nephrology : CJASN·Stanley M H YeungStephan J L Bakker

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