ArticleThe Journal of nutrition2013
Low protein nitrogen appearance as a surrogate of low dietary protein intake is associated with higher all-cause mortality in maintenance hemodialysis patients.
Article in The Journal of nutrition, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- What is the impact of dialysis on the nutritional status of patients according to sex? A systematic review with meta-analysis.Clinical and experimental nephrology · 2025Pooled it
- Long-term safety and decrease of pill burden by tenapanor therapy: a phase 3 open-label study in hemodialysis patients with hyperphosphatemia.Scientific reports · 2023Trial
- Trial
- Differential Associations of Lipopolysaccharide, Soluble NOX2-Derived Peptide, and Hydrogen Peroxide with Adiposity and Muscularity in Adults on Maintenance Hemodialysis.Antioxidants (Basel, Switzerland) · 2026Article
- Pathophysiology and potential treatment of uremic sarcopenia.Kidney research and clinical practice · 2026Article
- Type 2 diabetes mellitus with chronic kidney disease benefits from long-term restriction of dietary protein intake: a 10-year retrospective cohort study.BMC nutrition · 2025Article
- Diabetes and Glucose Management in People on Hemodialysis.Diabetes spectrum : a publication of the American Diabetes Association · 2025Article
- Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study.Nutrients · 2022Article
- Review
- Low Intracellular Water, Overhydration, and Mortality in Hemodialysis Patients.Journal of clinical medicine · 2020Article
- Impact of body mass index on survival in patients undergoing peritoneal dialysis: Analysis of data from the Insan Memorial End-Stage Renal Disease Registry of Korea (1985-2014).Kidney research and clinical practice · 2019Article
- Serum uric acid, protein intake and mortality in hemodialysis patients.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2017Article
- Review
- Dietary protein intake and chronic kidney disease.Current opinion in clinical nutrition and metabolic care · 2017Review
- Latest consensus and update on protein-energy wasting in chronic kidney disease.Current opinion in clinical nutrition and metabolic care · 2015Review
- Association of Processed Meat Intake with Hypertension Risk in Hemodialysis Patients: A Cross-Sectional Study.PloS one · 2015Article
- Protein-energy wasting, as well as overweight and obesity, is a long-term risk factor for mortality in chronic hemodialysis patients.International urology and nephrology · 2014Article
- Dietary restrictions in dialysis patients: is there anything left to eat?Seminars in dialysisReview
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
To determine the association between all-cause mortality and dietary protein intake in patients with chronic kidney disease, we performed a large-scale, 8-y prospective cohort study in 98,489 maintenance hemodialysis patients from a multicenter dialysis care provider. Compared with the reference level (60 to <70 g/d), low protein nitrogen appearance (PNA) levels [<30 g/d, HR: 1.40 (95% CI: 1.30, 1.50); 30 to <40 g/d, HR: 1.33 (95% CI: 1.28, 1.39)] was associated with higher all-cause mortality, and high PNA levels [≥110 g/d, HR: 0.92 (95% CI: 0.88, 0.97); 100 to <110 g/d, HR: 0.87 (95% CI: 0.82, 0.91)] were associated with lower all-cause mortality in all analyses. This association was also found in subanalyses performed among racial and hypoalbuminemic groups. Hence, using PNA as a surrogate for protein intake, a low daily dietary protein intake is associated with increased risk of death in all hemodialysis patients. Whether the association between dietary protein intake and survival is causal or a consequence of anorexia secondary to protein-energy-wasting/inflammation or other factors should be explored in interventional trials.
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Registered trials
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