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78 CPD ACTIVITY PROTEIN SUPPLEMENTS AND KIDNEY DAMAGE: SHOULD WE BE WORRIED? Carla Scuderi Carla Scuderi is the Pharmacist Team Leader for the Kidney Health Service based at Royal Brisbane and Women’s Hospital and a course coordinator in the University of Queensland Postgraduate Clinical Pharmacy Program. Carla has previously been a community pharmacy manager and owner and also an NPS and HMR facilitator. Her research interests include kidney transplants, kidney supportive care and pharmacist interventions. Dr Matthew Tunbridge Dr Matthew Tunbridge is a specialist nephrology trainee at the Royal Brisbane and Women’s Hospital. He has an interest in cardiovascular complications of kidney disease, and renal transplantation medicine. LEARNING OBJECTIVES After completing this CPD activity, pharmacists should be able to: • Describe the sources of dietary protein and how protein is metabolised. • Describe the theoretical risks associated with excessive protein consumption and chronic kidney disease. • List the risk factors and symptoms of acute kidney injury and approaches to reducing these risks. 2016 Competency Standards: 2.2, 2.3, 3.1, 3.2, 3.3, 3.6. Accreditation number: A2007RP3 (exp: 30/06/2022). We live in an ‘Insta’ world where the desirable body shape is constantly on full display, particularly for men. In Renaissance times, a well-turned ankle with a voluptuous figure was the sign of a wealthy and desirable male. Modern musclebound masculine trends started in the 1970s and ’80s with Sylvester Stallone and Arnold Schwarzenegger, and they were reinvigorated by celebrities such as Dwayne ‘the Rock’ Johnson and Chris Hemsworth. The ‘idolised’ male physique today is a triangular broad-shouldered upper torso, defined abdominal muscles and strong legs. An enormous industry has developed around diets, exercise regimens and supplements to quickly transform one’s body shape from zero to hero. As protein supplements are classified as foods, many of them are surrounded by media hype, celebrity endorsement and little if any science. The 2011–13 Australian Health Survey (AHS) a large and comprehensive survey of 12,000 people, found that 7.8 per cent of surveyed men in the 19-30-year- old category had consumed special dietary foods.1 A massive 75 per cent of these special dietary foods were protein supplements or sports nutrition powders.1 Sports nutrition is a $1.11 billion industry in the Australian economy, representing a significant part of the overall $5.2 billion complementary medicines market.2 Consumers consider community pharmacy as the best outlet for buying complementary medicines, with a total of 68 per cent of all complementary medicine purchases being made in pharmacy.2 While many protein supplements are sold directly by gyms, personal trainers and health ‘gurus’, community pharmacists have an obligation to understand actual or potential risks associated with the protein supplements they stock. What if any effects can the high protein supplements favoured by young men and body builders do to the body, in particular the excretory organs such as the kidney? Does the supraphysiological protein load have negative consequences on the kidneys? Are we exposing a generation of healthy young people to potential chronic kidney disease later in life? The kidneys The kidneys are amazing organs. These compact ‘bean’ shaped filters weighing around 150g each, process around 25 per cent of the total cardiac output or 1200ml of blood per minute.3 Kidneys play a vital role in the regulation of water and electrolyte content of the body by filtration, secretion and reabsorption.3 They maintain acid/base balance and are responsible for excretion of waste products, water soluble toxic substances and drugs through urine production.3 Additionally, the kidneys regulate a number of endocrine functions, such as the activation of erythropoietin, which maintains the blood’s haemoglobin and vitamin D. They also produce renin, which is important for water and electrolyte balance.3 Each kidney contains around one million individual filtering units called nephrons. These are unique systems in the larger organ and are exquisitely sensitive to changes in blood flow and fluid and electrolyte changes.3 Chronic kidney disease (CKD) is defined as kidney damage or decline in renal function by reduction in glomerular filtration rate (GFR) for greater than three months. Around one in 10 Australians have signs of CKD. But fewer than 10 per cent of people with CKD are aware they have the condition4 – meaning that more than 1.5 million Australians are unaware they have indicators of CKD.4 The leading causes of CKD in Australia are hypertension and diabetes, which accounts for 48 per cent of CKD.4 Other risk factors for CKD include established cardiovascular disease, family history, obesity, being Indigenous, >60 years of age and history of acute kidney injury (AKI).4 If detected early, CKD can be preventable with recommended lifestyle interventions such as diet, exercise, physical activity and smoking cessation.4 Dietary protein ingestion and metabolism Australian dietary guidelines recommend a healthy diet with a variety of vegetables, fruits, wholegrain cereals, lean meat, eggs, nuts, seeds and low fat diary.4 Protein is a macronutrient along with fats and fibre. Protein occurs in all living cells and has both functional and structural properties.5 The recommended distribution of nutrients from different food sources is as follows:5 • 15–25 per cent from protein. • 20–35 per cent of total energy intake from fats. • 45–65 per cent from carbohydrate. This equates to around 50-80g of protein daily.5 Dietary protein intake below this range increases the risk of chronic disease, obesity and inadequate micronutrient intake.5 Currently, insufficient data is available on the effects of protein consumption in excess of the recommended intake, especially if it’s sustained over long periods of time.6 Dietary protein is primarily derived from meat, eggs, milk and fish. Plant sources include soy proteins. Many protein shakes are formulated from whey, casein and egg-albumen based protein. The average RETAIL PHARMACY • JUL 2020 2 CPD CREDITS