Table 2.
Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals for mortality according to dietary protein intake 1.
| VLPI | LPI | MPI | 0.1 g/kg IBW/day Increment |
p Value 2 |
|||||
|---|---|---|---|---|---|---|---|---|---|
|
0.29 to 0.59
(g/kg IBW/day) |
0.60 to 0.80
(g/kg IBW/day) |
0.81 to 1.35
(g/kg IBW/day) |
|||||||
| Mean (SD) protein intake (g/kg IBW/day) | 0.52 (0.07) | 0.70 (0.06) | 0.93 (0.10) | ― | ― | ||||
| All-cause mortality | |||||||||
| No of deaths/patient years | 10/284.9 | 22/613.3 | 4/426.6 | ― | ― | ||||
| Rate/1000 patient years | 35.1 | (23.7 to 46.5) | 35.9 | (24.4 to 47.4) | 9.4 | (3.4 to 15.4) | ― | ― | |
| All | |||||||||
| Model 1 3 | 0.89 | (0.39 to 1.88) | 1.00 (ref) | 0.29 | (0.08 to 0.77) | 0.89 | (0.80 to 0.99) | <0.001 | |
| Model 2 4 | 1.42 | (0.55 to 3.44) | 1.00 (ref) | 0.29 | (0.07 to 0.94) | 0.76 | (0.60 to 0.95) | <0.001 | |
| Model 3 5 | 1.45 | (0.57 to 3.48) | 1.00 (ref) | 0.27 | (0.07 to 0.81) | 0.83 | (0.70 to 0.98) | <0.001 | |
| ≤65 years 6 | |||||||||
| Model 1 3 | 2.54 | (0.09 to 70.13) | 1.00 (ref) | 3.73 | (0.31 to 94.60) | 1.00 | (0.01 to 82.07) | 0.879 | |
| Model 2 4 | ― | ― | ― | ― | ― | ||||
| Model 3 5 | ― | ― | ― | ― | ― | ||||
| >65 years 6 | |||||||||
| Model 1 3 | 0.84 | (0.35 to 1.85) | 1.00 (ref) | 0.16 | (0.03 to 0.55) | 0.57 | (0.49 to 0.67) | <0.001 | |
| Model 2 4 | 1.52 | (0.51 to 4.27) | 1.00 (ref) | 0.14 | (0.02 to 0.69) | 0.65 | (0.47 to 0.89) | <0.001 | |
| Model 3 5 | 1.64 | (0.58 to 4.45) | 1.00 (ref) | 0.14 | (0.02 to 0.59) | 0.69 | (0.51 to 0.93) | <0.003 | |
| ESRD 7 | |||||||||
| No. of events/patient years | 22/171.6 | 48/436.0 | 27/340.8 | ― | ― | ||||
| Rate/1000 patient years | 128 | (107 to 149) | 110 | (90 to 129) | 79 | (63 to 96) | ― | ― | |
| All | |||||||||
| Model 1 3 | 0.97 | (0.58 to 1.60) | 1.00 (ref) | 0.70 | (0.43 to 1.16) | 1.00 | (0.21 to 4.85) | 0.689 | |
| Model 2 4 | 0.87 | (0.49 to 1.56) | 1.00 (ref) | 0.72 | (0.40 to 1.29) | 1.00 | (0.54 to 1.88) | 0.631 | |
| Model 3 5 | 0.83 | (0.47 to 1.47) | 1.00 (ref) | 0.62 | (0.35 to 1.09) | 1.00 | (0.62 to 1.64) | 0.722 | |
| ≤65 years 6 | |||||||||
| Model 1 3 | 1.20 | (0.43 to 2.93) | 1.00 (ref) | 0.71 | (0.28 to 1.69) | 1.00 | (0.01 to 81.05) | 0.508 | |
| Model 2 4 | 8.31 | (0.78 to 88.42) | 1.00 (ref) | 0.92 | (0.14 to 6.07) | 1.01 | (0.21 to 4.83) | 0.039 | |
| Model 3 5 | 4.12 | (0.47 to 36.26) | 1.00 (ref) | 0.78 | (0.14 to 4.22) | 1.01 | (0.24 to 4.31) | 0.054 | |
| >65 years 6 | |||||||||
| Model 1 3 | 0.80 | (0.42 to 1.47) | 1.00 (ref) | 0.85 | (0.45 to 1.57) | 1.00 | (0.17 to 5.87) | 0.719 | |
| Model 2 4 | 0.46 | (0.20 to 1.06) | 1.00 (ref) | 0.60 | (0.27 to 1.37) | 1.00 | (0.49 to 2.04) | 0.778 | |
| Model 3 5 | 0.47 | (0.21 to 1.03) | 1.00 (ref) | 0.70 | (0.33 to 1.48) | 1.00 | (0.49 to 2.06) | 0.757 | |
1 All values are mean (SD), number and relative hazards (95% confidence interval). All estimates were derived from multivariable Cox proportional hazards regression models. Bold values are statistically significant (p < 0.05). “―” signs not calculated the statistic values in the table. ESRD, end-stage renal disease. 2 p-linear trend was calculated by using the Wald test statistic. 3 Multivariable Model 1 included age, sex, BMI, CKD stage, and comorbidities (DM, CVD, and anemia). 4 Multivariable Model 2 included Model 1 plus alcohol drinking status, smoking status, blood biochemistry (phosphate, albumin, CRP, and BNP), drugs (ESA, anti-hyperuricemia, phosphate binders, anti-hyperlipidemia, and RASi), systolic blood pressure, LVEF, total-body skeletal muscle mass, urinary protein excretion, urinary sodium excretion, and max-IMT. 5 Multivariable Model 3 included multiple imputation for missing data (24-h urine collection: n = 21) for sensitivity analysis, and it was adjusted by factors in Model 2. Numbers of patients with very low protein intake (VLPI), low protein intake (LPI), and moderate protein intake (MPI) were 65, 158, and 119, respectively. 6 To estimate association between protein intake and age, age-stratified (≤65 and >65 years) models [27] were used. 7 End-stage renal disease included hemodialysis, peritoneal dialysis, and kidney transplantation.