Validity of a self-dietary assessment nutrition application (nutrirodcal) for estimating protein intake in patients with chronic kidney disease
- 1Division of Nephrology, Department of Medicine, Rajavithi Hospital, College of medicine, Rangsit University, Bangkok, Thailand; Corresponding author.
- 2Division of Cardiology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
Abstract
Background: Accurate assessment of dietary protein intake is essential in the management of chronic kidney disease (CKD). However, biochemical approaches such as 24-hour urinary urea nitrogen (UUN) collection are impractical in routine care. Digital dietary assessment tools may provide a feasible alternative, but validation in CKD populations remains limited. Objective: To evaluate the validity of the Nutrirodcal digital dietary assessment application in estimating dietary protein intake compared with normalized protein equivalent of total nitrogen appearance (nPNA) derived from 24-hour UUN in patients with predialysis CKD. Methods: In this prospective validation study, adult patients with CKD stages 3–5 recorded dietary intake using the Nutrirodcal application. Protein intake estimated by the application (DPI) was compared with nPNA at weeks 4, 8, and 12. Agreement was assessed using two-way mixed-effects intraclass correlation coefficients (ICC) for absolute agreement and Bland–Altman analysis. Pearson correlation coefficients were also calculated. Results: Twenty-six participants were enrolled. Of these, 21 participants completed the 12-week follow-up and had complete paired Nutrirodcal and nPNA measurements at weeks 4, 8, and 12 (mean age 60 ± 9.9 years; 57% male). Moderate agreement between DPI and nPNA was observed (ICC range 0.413–0.510). Pearson correlations were significant at week 4 (r = 0.485, P = 0.026) and week 8 (r = 0.510, P = 0.018), with a non-significant trend at week 12 (r = 0.414, P = 0.062). Bland–Altman analysis showed small mean bias but wide limits of agreement, particularly at week 12. Conclusion: In this small, selected pilot cohort, Nutrirodcal showed small average bias but limited individual-level agreement with nPNA derived from 24-hour UUN. These findings provide preliminary methodological evidence and do not support replacing biochemical or dietitian-led assessment. Nutrirodcal may be considered an adjunct for protein-intake self-monitoring, while comprehensive CKD nutritional care should continue to address energy, sodium, potassium, phosphorus, fluid, and overall nutritional status.
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BibTeX
@article{arayangkoon2026validity,
title = {{Validity of a self-dietary assessment nutrition application (nutrirodcal) for estimating protein intake in patients with chronic kidney disease}},
author = {Chantisa Arayangkoon and Wittawat Wattanas},
journal = {Clinical Nutrition Open Science},
year = {2026},
month = nov,
doi = {10.1016/j.nutos.2026.100755},
url = {https://doi.org/10.1016/j.nutos.2026.100755},
note = {CC BY},
}
RIS
TY - JOUR
TI - Validity of a self-dietary assessment nutrition application (nutrirodcal) for estimating protein intake in patients with chronic kidney disease
AU - Chantisa Arayangkoon
AU - Wittawat Wattanas
PY - 2026
DA - 2026/11/04
JO - Clinical Nutrition Open Science
DO - 10.1016/j.nutos.2026.100755
UR - https://doi.org/10.1016/j.nutos.2026.100755
AB - Background: Accurate assessment of dietary protein intake is essential in the management of chronic kidney disease (CKD). However, biochemical approaches such as 24-hour urinary urea nitrogen (UUN) collection are impractical in routine care. Digital dietary assessment tools may provide a feasible alternative, but validation in CKD populations remains limited. Objective: To evaluate the validity of the Nutrirodcal digital dietary assessment application in estimating dietary protein intake compared with normalized protein equivalent of total nitrogen appearance (nPNA) derived from 24-hour UUN in patients with predialysis CKD. Methods: In this prospective validation study, adult patients with CKD stages 3–5 recorded dietary intake using the Nutrirodcal application. Protein intake estimated by the application (DPI) was compared with nPNA at weeks 4, 8, and 12. Agreement was assessed using two-way mixed-effects intraclass correlation coefficients (ICC) for absolute agreement and Bland–Altman analysis. Pearson correlation coefficients were also calculated. Results: Twenty-six participants were enrolled. Of these, 21 participants completed the 12-week follow-up and had complete paired Nutrirodcal and nPNA measurements at weeks 4, 8, and 12 (mean age 60 ± 9.9 years; 57% male). Moderate agreement between DPI and nPNA was observed (ICC range 0.413–0.510). Pearson correlations were significant at week 4 (r = 0.485, P = 0.026) and week 8 (r = 0.510, P = 0.018), with a non-significant trend at week 12 (r = 0.414, P = 0.062). Bland–Altman analysis showed small mean bias but wide limits of agreement, particularly at week 12. Conclusion: In this small, selected pilot cohort, Nutrirodcal showed small average bias but limited individual-level agreement with nPNA derived from 24-hour UUN. These findings provide preliminary methodological evidence and do not support replacing biochemical or dietitian-led assessment. Nutrirodcal may be considered an adjunct for protein-intake self-monitoring, while comprehensive CKD nutritional care should continue to address energy, sodium, potassium, phosphorus, fluid, and overall nutritional status.
SN - 2667-2685
ER -