Page 80 - Demo

amount of protein in a protein shake is 30g per serve. This is generally taken either pre- or post-workout. Some people choose to add an additional 5g of creatine as an amino acid supplement.7 The exact composition of the protein shake may be either high or low in carbohydrate, depending on whether the consumer is ‘cutting’ or ‘bulking’. Some supplements can contain additional ingredients such as caffeine to increase the intensity of the workout.7 Protein is considered to be the premier ingredient in weight gain- promoting supplements. The International Olympic Committee ‘Consensus Statement on Supplements and High Performance Athletes’ states that protein is effective at promoting lean mass gain when combined with resistive exercise.7 When protein is ingested, it’s broken down in the small intestine into a carbon skeleton of amino acids. These are used to build new proteins and cells or for energy production. The waste products of urea and nitrogen are presented to the kidney for recycling and excretion.8 If the urea generated via this process accumulates (in AKI or CKD), it can produce:8 • Oxidative stress. • Inflammation. • Endothelial dysfunction. • Cardiovascular disease. CKD and dietary protein There is no established evidence that dietary protein loading causes CKD.9 Nevertheless, numerous studies have linked increased dietary protein with higher rates of the disease. The potential mechanisms for harm are outlined in Table 1.10 Each of these will be discussed. Glomerular haemodynamics Acute protein loading can have profound effects on renal haemodynamics. Some studies suggest that dietary protein loading can increase renal glomerular filtration rate (GFR), or renal blood flow, by as much as 100 per cent.10 This phenomenon, known as Table 1. Established or theoretical renal risks from excessive protein intake10 CPD ACTIVITY 79 nephrotic syndrome.3 Increased protein consumption and heavy exercise can increase proteinuria.4 Fluid and electrolyte imbalances The largest source of dietary acid load is via protein intake.8 Increased acid loads are associated with multiple chronic health conditions, including chronic kidney disease, hypertension, and bone/metabolic abnormalities.8 High-protein diets are often accompanied by deliberate carbohydrate restriction to establish a state of ketosis.10 The justification for this regimen is that ketosis will aid weight loss. But it can also cause salt and water losses from the kidneys that can lead to severe electrolyte abnormalities, volume depletion and metabolic acidosis. This can in turn lead to AKI or CKD.10 Blood pressure Dietary manipulation can modulate blood pressure, and hypertension is a known risk factor for CKD.10 Diets high in fruit, vegetables and low-fat dairy have been shown to reduce blood pressure in overweight, hypertensive individuals.10 High-protein diets where the protein is meat based have been shown to increase blood pressure, as these diets are often high in saturated fats and relatively light on vegetables and grains.10 High-protein diets from non-meat sources and where weight loss is achieved may actually improve blood pressure due to the positive effects of weight loss. Interestingly, high-protein diets (from shakes) have been associated with orthostatic hypotension.10 Kidney stones Diet plays a large role in kidney stone formation, and kidney stones can be a cause of AKI and CKD. A higher intake of animal protein has been shown to cause a reduction in urinary pH, increased urinary urea and calcium, and reduced urinary citrate. This can lead to increased kidney stone formation.10 However, a diet high in protein from non-animal sources has not TO PAGE 80 Glomerular haemodynamics Hyperfiltration Hyperaemia Accelerated GFR decline Increased urinary protein (albumin) excretion Fluid electrolyte, and acid-base status Natriuresis Kaliuresis Diuresis Metabolic acidosis Increased water consumption Blood pressure Hypertension Orthostatic hypotension Kidney stone risks Hyperuricosuria Hypercalciuria Hypocitraturia Reduction in urinary pH Metabolic Dyslipidaemia Hyperuricaemia Weakness Fatigue Exacerbation of uraemia hyperfiltration, can cause progressive sclerosis (scarring) of nephrons with the attendant problems of CKD including:10 • Proteinuria. • Disruptions to fluid and electrolyte balance. • Increases in blood pressure. • Other metabolic changes including hypercholesterolaemia and gout. Proteinuria Proteinuria is generally defined as the presence of albumin in the urine at a level above 300mg/day.4 Proteinuria is often the first sign of CKD. Its presence has been shown to increase the rate of decline of renal function.3 Often an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) may be prescribed to reduce proteinuria. Protein excretion of up to 150mg per day is considered normal. About 30mg of this will be albumin. However, protein losses of >1g/day warrant investigation and treatment. Loss of >3g/day is considered heavy proteinuria that may accompany the Medication Management Review accreditation The Australian College of Pharmacy MMR Stage One course benefits: Student College member Non-member $258.60 $399.00 $844.90 • Complete online delivery - no face-to-face training • Complete the course in your own time from anywhere • Contains practice case studies • Bonus module “Building your MMR service” • Comprehensive feedback on your case studies from an experienced stage 2 assessor • Great value for money www.acp.edu.au info@acp.edu.au 07 3144 3680 RETAIL PHARMACY • JUL 2020