Nutritional treatment in chronic kidney disease: the concept of nephroprotection (original) (raw)
Related papers
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.
Dietary Protein Restriction and Preservation of Kidney Function in Chronic Kidney Disease
Blood Purification, 2013
Dietary protein augmentation elicits an increase in single nephron glomerular filtration rate (GFR) and increased transglomerular pressure. This is similar to the hemodynamic response to reduction in renal mass. Among patients and experimental animals with proteinuric renal disease, these changes also cause an increase in glomerular permselectivity, which in experimental animals accelerates loss of renal function. A meta-analysis of a group of prospective randomized trials including over 2,000 patients found a significant effect on reducing dietary protein decreasing the risk of end-stage renal disease or death (defined as renal death). This differs somewhat in the outcomes of clinical trials using intermediate outcomes, such as the Modification of Diet in Renal Disease study that used change in GFR in part because of the initial hemodynamic effect of reduction in GFR mediated by dietary protein restriction.
Hippokratia, 2011
The possible deleterious effect of meet consumption upon deterioration of renal disease was speculated from Lionel Beale as early as 1869. The first attempt to apply a very low protein diet in humans is attributed to Millard Smith who prescribed a diet consisting of 300 mg protein per day in a volunteer medical student for 24 days. Unfortunately, in early 20(th) century, prescribing very low protein diets among patients suffering from renal disease complicated with malnutrition and the medical practice of this era turned to the recommendation of high protein diets because it was believed that protein consumption is coupled with the strength of civilized man. In mid sixties Giordano and Giovanetti introduced low protein diets in the treatment of uremic patients but their efforts did not accepted from the medical community. Meanwhile the evolution of haemodialysis, peritoneal dialysis and transplantation as effective methods of treating end stage renal disease guided doctors and patie...
Dietary Protein Restriction in the Management of Chronic Kidney Disease
2008
The number of patients with chronic kidney disease (CKD) – especially with diabetic nephropathy – is expected to grow significantly in the future.1,2 CKD is associated with substantial morbidity and mortality, and the consequence of this emerging public health problem is considerable consumption of medical and financial resources. This epidemic has led to the development of therapeutic and management guidelines to improve overall health in patients with CKD, e.g. the Kidney Disease Outcomes Quality Initiative (KDOQI). Dietary management is a tried and true method of helping to maintain the health of CKD patients. In this article, we will discuss the metabolic effects of dietary protein and the essential role of dietary protein restriction in the management of patients with CKD.
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...
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.
Supplemented low-protein diets--are they superior in chronic renal failure?
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1995
Twenty-two patients with chronic renal failure were randomly assigned to a conventional low-protein diet containing 0.6 g protein/kg/day or a very-low-protein diet containing 0.4 g protein/kg/day supplemented with essential amino acids; they were followed up for 9 months. There were no significant changes in body mass index, arm muscle area, percentage body fat, serum albumin and transferrin levels in any of the groups; neither was there any difference between the groups in respect of these parameters. Renal function, as measured by the reciprocal of serum creatinine over time, stabilised in both groups during intervention, with no significant difference between the groups. There was however no correlation between changes in renal function and changes in blood pressure, or dietary intake of protein, phosphorus, cholesterol, polyunsaturated and saturated fatty acids. There were also no significant changes and no significant differences between the groups in serum levels of parathyroi...
Positive Effects of Protein Restriction in Patients With Chronic Kidney Disease
Journal of Renal Nutrition, 2008
Objectives: The potential benefit or harm of low-protein diets (LPDs) for patients with chronic kidney disease has been debated. This study sought to investigate the effects of treatment with LPDs on nutritional markers, morbidity, and survival during subsequent dialysis. A second objective was to evaluate the effect of LPDs on renal function and the start of dialysis. Design: This was a retrospective study of medical records. Setting: The setting was an outpatient nephrology and dialysis clinic. Patients: One-hundred twenty-two renal patients were recruited from the central dialysis registry of one clinic. The patients had been followed by a nephrologist for $6 months before dialysis. Sixty-one patients were treated with LPDs, and an equal number of control patients not treated with LPDs were matched for sex, age, dialysis modality, diabetes, and start of dialysis. Main Outcome Measures: Main outcome measures included weight and weight change, serum albumin, glomerular filtration rate, morbidity, and mortality. Results: There was less mean weight loss in the LPD group the year before dialysis (0.14 kg/month, compared with the control group at 0.36 kg/month, P , .05). The level of serum albumin was higher in the LPD group at the start of dialysis (P , .01). The mean rate of progression during the 6 months before dialysis was lower in the LPD group (4.1 mL/min/year) than in the control group (13.4 mL/min/year) (P , .001). The LPD group had fewer days of hospitalization at the start of dialysis than the control group (8.2 vs 15.4 days, respectively, P , .01). There was no difference in mortality between groups 1, 2, or 5 years after starting dialysis. Conclusions: Low-protein diets can reduce patient morbidity, preserve renal function, relieve uremic symptoms and improve nutritional status. The results suggest that LPDs can postpone the start of dialysis for 6 months, and entail substantial cost-savings. Low-protein diets should be used more generally in the renal community.
Kidney International, 1997
Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study. The safety of dietary protein and phosphorous restriction was evaluated in the Modification of Diet in Renal Disease (MDRD) Study. In Study A, 585 patients with a glomerular filtration rate (GFR) of 25 toSS ml/min/l.73 m2 were randomly assigned to a usual-protein diet (1.3 glkglday) or a low-protein diet (0.58 g/kglday). In Study B, 255 patients with a GFR of 13 to 24 ml/min/l.73 m2 were randomly assigned to the low-protein diet or a very-low-protein diet (0.28 g/kg/day), supplemented with a ketoacid-amino acid mixture (0.28 g/kg/ day). The low-protein and very-low-protein diets were also low in phosphorus. Mean duration of follow-up was 2.2 years in both studies. Protein and energy intakes were lower in the low-protein and very-low-protein diet groups than in the usual-protein group. Two patients in Study B reached a "stop point" for malnutrition. There was no difference between randomized groups in the rates of death, first hospitalizations, or other "stop points" in either study. Mean values for various indices of nutritional status remained within the normal range during follow-up in each diet group. However, there were small but significant changes from baseline in some nutritional indices, and differences between the randomized groups in some of these changes. In the low-protein and very-low-protein diet groups, serum albumin rose, while serum transferrin, body wt, percent body fat, arm muscle area and urine creatinine excretion declined.