Metabolic effects of two low protein diets in chronic kidney disease stage 4-5--a randomized controlled trial (original) (raw)
Related papers
Nutrition in Chronic Kidney Disease—The Role of Proteins and Specific Diets
Nutrients, 2021
Chronic kidney disease (CKD) is a global public health burden, needing comprehensive management for preventing and delaying the progression to advanced CKD. The role of nutritional therapy as a strategy to slow CKD progression and uremia has been recommended for more than a century. Although a consistent body of evidence suggest a benefit of protein restriction therapy, patients’ adherence and compliance have to be considered when prescribing nutritional therapy in advanced CKD patients. Therefore, these prescriptions need to be individualized since some patients may prefer to enjoy their food without restriction, despite knowing the potential importance of dietary therapy in reducing uremic manifestations, maintaining protein-energy status.
Hong Kong Journal of Nephrology, 2014
Introduction: A low-protein diet supplemented with ketoanalogues (KAs) has been shown to be effective in improving the benefits of a low-protein diet for patients with chronic kidney disease (CKD). Materials and methods: A total of 178 adult patients with CKD Stages 3e5 (predialysis) were assessed for 1 year. A total of 122 patients were in the KA-supplemented low-protein diet (sLPD) group and were prescribed 0.6 g/kg body weight (BW) of dietary proteins supplemented with one KA tablet for every 10 kg BW. The remaining 56 patients were in the KA-supplemented very-low-protein diet (sVLPD) group and received 0.3 g/kg BW of dietary protein supplemented with one KA tablet for every 5 kg BW. Renal, metabolic, and nutritional parameters, and anthropometric assessments were performed for all patients. Results: We assessed the renal function of the patients. There was no difference in the baseline clinical and laboratory characteristics between the sLPD and sVLPD groups. In the sLPD group, the blood urea level decreased from 85.38 AE 4.45 to 76.90 AE 42.90 mg/dL (p < 0.05) after 12 months. CKD stagewise assessment of the 24-hour urinary creatinine clearance (CrCl) showed an improving trend of renal function. In the sVLPD group, the blood urea level after 6 months decreased from 98.38 AE 42.97 to 79.84 AE 34.15 mg/dL (p < 0.05), but it increased to 102.74 AE 45.98 mg/dL (p > 0.05) at the end of 1 year. The CrCl showed a marginal increase at the end of 1 year, but this increase was not statistically significant. There was a decrease in urinary protein excretion in both groups. Anthropometric measurement, including Subjective Global Assessment, showed nutritional improvement in both groups. Pearson correlation coefficient between protein intake and urinary nitrogen appearance showed positive correlation between the two groups.
BMC Nephrology, 2016
Background: Chronic kidney disease (CKD) is a worldwide public health problem and more so in India. With limited availability and high cost of therapy, barely 10 % of patients with incident end stage renal disease (ESRD) cases get treatment in India. Therefore, all possible efforts should be made to retard progression of CKD. This article reviews the role of low protein diet (LPD) in management of CKD subjects and suggests how to apply it in clinical practice. Discussion: The role of LPD in retarding progression of CKD is well established in animal experimental studies. However, its role in human subjects with CKD is perceived to be controversial based on the modification of diet in renal disease (MDRD) study. We believe that beneficial effect of LPD could not be appreciated due to shorter duration of follow-up in the MDRD study. Had the study been continued longer, it may have been possible to appreciate beneficial effect of LPD. It is our contention that in all cases of CKD that are slowly progressive, LPD can significantly retard progression of CKD and delay the need for renal replacement therapy (RRT). To be able to apply LPD for a long period, it is important to prescribe LPD at earlier stages (1,2,3) of CKD and not at late stage as recommended by KDIGO guidelines. Many clinicians are concerned about worsening nutritional status and hence reluctant to prescribe LPD. This actually is true for patients with advanced CKD in whom there is spontaneous decrease in calorie and protein intake. In our experience, nutritional status of patients in early stages (1,2,3) of CKD is as good as that of healthy subjects. Prescribing LPD at an early stage is unlikely to worsen status. Summary: The role of LPD in retarding progression of CKD is well established in animal experimental studies. Even in human subjects, there is enough evidence to suggest that LPD retards progression of CKD in carefully selected subjects. It should be prescribed to those with good appetite, good nutritional status and a slowly progressive CKD at an early stage (stage 1,2,3). It may also be prescribed at stage 4 & 5 of CKD if the appetite and nutritional status are good.
Journal of Clinical Medicine
The 2020 Kidney Disease Outcome Quality Initiative (KDOQI) Clinical Practice Guideline for Nutrition in chronic kidney disease (CKD) recommends protein restriction to patients affected by CKD in stages 3 to 5 (not on dialysis), provided that they are metabolically stable, with the goal to delay kidney failure (graded as evidence level 1A) and improve quality of life (graded as evidence level 2C). Despite these strong statements, low protein diets (LPDs) are not prescribed by many nephrologists worldwide. In this review, we challenge the view of protein restriction as an “option” in the management of patients with CKD, and defend it as a core element of care. We argue that LPDs need to be tailored and patient-centered to ensure adherence, efficacy, and safety. Nephrologists, aligned with renal dietitians, may approach the implementation of LPDs similarly to a drug prescription, considering its indications, contra-indications, mechanism of action, dosages, unwanted side effects, and s...
Dietary Protein Intake in Patients with Advanced Chronic Kidney Disease and on Dialysis
Seminars in Dialysis, 2010
Many patients with chronic kidney disease (CKD), particularly those with stage 5 CKD, have protein wasting. The degree to which increased morbidity and mortality seen in these patients is due to protein depletion rather than to the often accompanying comorbidity is not clear. High protein diets lead to the accumulation of metabolites of protein that are potentially toxic. The MDRD Study, which investigated the effects of three levels of dietary protein and phosphorus intakes and two blood pressure goals on the progression of CKD, has several limitations. Several meta-analyses have examined the effects of low protein diets (LPD) on the progression of CKD. It is possible that the lower SUN levels or lesser degree of uremic symptoms may have contributed to the positive findings of LPD in the meta-analyses of Fouque and Pedrini et al., when compared with the study of Kasiske et al. A number of published reports indicate that LPD provide adequate protein for almost all clinically stable CKD patients and do not adversely affect body composition. In general, there are no large differences in the protein intake recommended by different expert groups for a given stage of CKD.
Very Low Protein Diet for Patients with Chronic Kidney Disease: Recent Insights
Journal of Clinical Medicine
Use of nutritional therapy (NT) in chronic kidney disease (CKD) patients is still debated among nephrologists, but it represents a fundamental point in the conservative treatment of CKD. It has been used for years and it has new goals today, such as (1) the reduction of edema, diuretics, and blood pressure values with a low sodium-content diet; (2) the dose reduction of phosphate levels and phosphate binders; (3) the administration of bicarbonate with vegetables in order to correct metabolic acidosis and delay CKD progression; (4) the reduction of the number and the doses of drugs and chemical substances; and (5) the lowering of urea levels, the cure of intestinal microbioma, and the reduction of cyanates levels (such as indoxyl-sulphate and p-cresol sulphate), which are the most recent known advantages achievable with NT. In conclusion, NT and especially very low protein diet (VLPD) have several beneficial effects in CKD patients and slows the progression of CKD.
A CROSS SECTIONAL STUDY OF NUTRITIONAL ASSESSMENT IN CHRONIC KIDNEY DISEASE PATIENTS.
Background: Chronic kidney disease is one of the global burdens, more so in developing countries where the medical facility is not abundantly available in the rural areas. Along with comorbid conditions, protein energy malnutrition plays a vital role in progression of renal disease. Proper diet management can decrease the rapid progression of chronic kidney disease. Though many studies have been done in other countries regarding the nutritional assessment in chronic kidney disease patients, it is mandatory to assess the prevalence of malnutrition in the rural or urban population of developing country. Methods: 100 consecutive patients were enrolled for the study. After obtaining written consent, history regarding the demographic data, duration of the disease, associated clinical features and 24 hour dietary recall were obtained. Then basic anthropometric parameters such as height, weight, Body Mass Index, skin fold thickness and mid arm circumference was measured. Later laboratory parameters such as haemoglobin, serum urea, serum creatinine, calcium, phosphorus, uric acid, total protein and serum albumin was measure. Results: The prevalence of protein energy malnutrition is 36% in our study which is more prevalent in the male gender as the total number of male patients are predominant in our study. And the patients in the initial stages of CKD are not aware of low protein diet. It is advisable to introduce dietary management along with medical management in all stages of chronic kidney disease patients. Conclusion: The incidence of PEM among the study population is nearly high but proper nutritional knowledge is lacking in these patients. Hence it is mandatory to introduce dietary management along with medical management in all stages of CKD so that rapid progression to end stage renal disease can be delayed.. It is also identified that severe protein energy malnutrition itself increases the mortlity of the patients. Small population, unequal gender and age distribution, shorter time period and unavailability of data for stage 1 CKD were the major limitations of the study. Hence in the future rectifying all the above said limitations such a study has to repeated periodically for better understanding of the study which will further improve the patient care and may help in reducing the early progression of the kidney disease.a large randomised control study can throw mucy light in the management of PEM in CKD patients.