Objective
Renal reserve (RR) measures the increase in glomerular filtration rate (GFR) in response
to a protein load; lack of RR could indicate subclinical kidney disease but such a
test is not routinely used in clinical practice. The purpose of this study was to
compare a meat versus liquid protein load in a cystatin C–based (Cys-C) RR test using
cimetidine-inhibited creatinine clearance (Cr Cl) and iohexol infusion clearance (Io
Cl) for validation. The design was cross-sectional analysis and the setting was a
Clinical Research Center.
Subjects
Participants (N = 16), mean (standard deviation [SD]) age 22 (2) years, had normal health and blood
pressure without proteinuria.
Intervention
Participants 1 to 8 received a beef burger (1 g/kg protein) and participants 9 to
16 received a ProCel shake (1-1.5 g/kg protein).
Main Outcome Measure
RR defined as the difference in stimulated versus baseline GFR.
Results
Baseline GFR (SD) in mL/minute/1.73 m2 averaged 103.0 (15.6) for Cr Cl, 94.8 (7.9) for Io Cl, and 117.0 (6.0) for Cys-C
estimated GFR (eGFR). Mean RR (SD) for the burger group (N = 8, mL/minute/1.73 m2) was 16.6 (12.3) for Cr Cl (P = .006); 7.2 (3.7) for Io Cl (P < .001), and 4.9 (2.6) for Cys-C eGFR (P = .001). Mean RR for the shake group (N = 8) was 15.8 (5.8) for Cr Cl (P < .001), 10.1 (7.8) for Io Cl (P = .008), and 2.4 (2.9) for Cys-C eGFR (P = .05).
Conclusion
Protein loading stimulates Io Cl and Cr Cl after a beef or milk-based protein load.
The change in Cys-C eGFR is significant but smaller for the shake and burger group,
which may be due to the dilutional effect of water loading or the length of Cys-C
half-life in the blood.
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Article Info
Publication History
Published online: April 04, 2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 by the National Kidney Foundation, Inc. All rights reserved.
