Protein loss is increased by 20-30% in cases of ED due to psoriasis and 10-15% in cases of ED due to other causes. These extra losses of proteins are to be supplemented in addition to daily normal requirement. Daily protein requirement is 1gm/kg.in a normal healthy adult. A patient of ED due to psoriasis weighing 60 kg requires total daily protein of 72-78 gm/day. But in CKD, highest daily allocation of protein is 0.8 gm/kg. Then, what will be the daily protein supplement in a patient of ED due to psoriasis with CKD?
The main reason for protein restriction in CKD is to reduce renal function decline. In patients with non-nephrotic CKD, the MDRD Study reported no difference in outcome (ESRD or death) in patients receiving a low (0.58 g/kg/day) vs. very low (0.28 g/kg/day) protein diet. When comparing patients on the usual protein diet (1.3 g/kg/day) to a low protein diet, there were no differences in GFR decline. With many studies reporting variable outcomes of protein restriction on CKD outcomes, the effect is at most modest.
Nephrotic syndrome patients may require an increased protein diet with one study recommending 0.8 g/kg/day plus 1 g for every gram of proteinuria and 35 kcal/kg/day. This may be analogous with non-nephrotic CKD patients with ED.
Other benefits of protein restriction also include reduced uraemic toxin synthesis, and a decreased phosphate and acid load (reducing metabolic acidosis).
To avoid malnutrition, the caloric intake of other nutrients such as carbohydrates needs to increase.
In the case of increased protein losses with cutaneous disorders, it may be reasonable to continue with 1.0 - 1.3 g/kg/day of protein intake.
You will not find any paper specifically looking at ED, CKD and protein intake. My response is an opinion extrapolated from other studies focussing on protein restriction and CKD outcomes.
Here is a recent systematic review and metanalysis from PloS One:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206134
thank you, very useful, i'm very interested in diseases that affect the total protein/albumin levels, any other published information will be appreciated.
Thanks Yazied Chothia and Sivapregasen Gasen Naidoo for your interests and valuable response
Thank you for the interesting discussion !
Kanthraj et al. (1999) observed that patients with ED secondary to drug reactions, eczema, and psoriasis lost 7.2, 9.6, and 22.6 g of scale with a protein content of 4.2, 5.6, and 12.8 g respectively. Obviously it depends on the protein loss first. If you divide the protein loss in ED to the body weight (kg) you can add to 0.8g/kg/d. If you calculate - it doesn’t exceed 1.0g/kg/d. (I would personally continue with that value). According to your arguments in cases of bigger protein loss the substitution should not exceed 1.3g/kg/d.
In what patients was studied the usual protein diet (1.3 g/kg/day) vs a low protein diet - CKD? Does the CKD stage also matter?
"To avoid malnutrition, the caloric intake of other nutrients such as carbohydrates needs to increase.
In the case of increased protein losses with cutaneous disorders, it may be reasonable to continue with 1.0 - 1.3 g/kg/day of protein intake."
It would have good to have some data on TB patients who have been administered protein with positive a recovery, including 1st line anti drugs
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