Resistance Training Enhances the Value of Protein Restriction in the Treatment of Chronic Kidney Disease

• Diet, protein restricted
• Kidney failure, chronic
• Weight lifting
• Protein-energy malnutrition
• Hypoalbuminemia

Since 1972, when Social Security extended Medicare coverage to patients younger than 65 years of age with end-stage renal disease (ESRD), more than 1 million such patients have entered the program (1). Period prevalence for ESRD in 1998 was 397 971 persons at a cost of $16.74 billion, with 87 534 new beneficiaries of treatment (2). It is projected that by 2010, the number of patients treated for ESRD will be 651 330, at a cost of $28.3 billion (1). Accordingly, a significant effort is now being made to reduce the incidence of ESRD by slowing the rate of progression of chronic kidney disease. An estimated 10.9 million Americans 12 years of age and older have a serum creatinine concentration of 133 µmol/L (1.5 mg/dL) or greater, and 0.8 million have a creatinine concentration of 177 µmol/L (2 mg/dL) or greater (1). These are the at-risk patients who must be targeted for intervention.

Proven methods for slowing progression of chronic kidney disease include therapy with angiotensin-converting enzyme inhibitors (3) and angiotensin receptor blockers (4). Use of a low-protein diet to slow progression is controversial (5–8) but is probably efficacious (7–9), even in patients with nephrotic-range proteinuria (6, 7). Such diets have been shown to diminish uremic symptoms and alleviate some of the complications of chronic kidney disease, including renal osteodystrophy, insulin resistance, and metabolic acidosis (6), all of which may prolong the time to initiation of renal replacement therapy (10). In addition, a recent study …