Very Low Protein Diet for Patients with Chronic Kidney Disease: Recent Insights (original) (raw)
Related papers
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...
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.
Nephrology Dialysis Transplantation, 2007
Background. International guidelines have not reached a complete agreement about the optimal amount of dietary proteins in chronic kidney disease(CKD). The aim of this study was to compare, with a randomizedcontrolled design, the metabolic effects of two diets with different protein content (0.55 vs 0.80 g/kg/day) in patients with CKD stages 4-5. Methods. Study design and sample size calculations were based on previously published experience of our group with low protein diet. The primary outcome of the study was the modification of serum urea nitrogen concentration. From 423 patients randomly assigned to the two diets 392 were analysed: 200 for the 0.55-Group and 192 for the 0.8-Group. The follow-up ranged 6-18 months. Results. Mean age was 61AE18 years, 44% were women, mean eGFR was 18AE7 ml/min/month. Three months after the dietary assignment and throughout the study period the two groups had a significantly different protein intake (0.72 vs 0.92 g/kg/day). The intentionto-treat analysis did not show any difference between the two groups. Compliance to the two test diets was significantly different (P < 0.05): 27% in the 0.55-Group and 53% in the 0.8-Group, with male gender and protein content (0.8 g/kg/day) predicting adherence to the assigned diet. The per protocol analysis, conversely, showed that serum urea nitrogen, similar at the time of randomization, significantly increased in the 0.8-Group vs 0.55-Group by 15% (P < 0.05). Serum phosphate, PTH and bicarbonate resulted similar in the two groups throughout the study. The 24 h urinary urea nitrogen significantly decreased after the first 3 months in 0.55-Group (P < 0.05), as well as the excretion of creatinine, sodium and phosphate (P < 0.05 vs baseline) and were significantly lower than the 0.8-Group. The prescription of phosphate binders, allopurinol, bicarbonate supplements and diuretics resulted significantly less frequent in the 0.55-Group (P < 0.05).
Low-protein diets for chronic kidney disease patients: the Italian experience
BMC Nephrology, 2016
Background: Nutritional treatment has always represented a major feature of CKD management. Over the decades, the use of nutritional treatment in CKD patients has been marked by several goals. The first of these include the attainment of metabolic and fluid control together with the prevention and correction of signs, symptoms and complications of advanced CKD. The aim of this first stage is the prevention of malnutrition and a delay in the commencement of dialysis. Subsequently, nutritional manipulations have also been applied in association with other therapeutic interventions in an attempt to control several cardiovascular risk factors associated with CKD and to improve the patient's overall outcome. Over time and in reference to multiple aims, the modalities of nutritional treatment have been focused not only on protein intake but also on other nutrients. Discussion: This paper describes the pathophysiological basis and rationale of nutritional treatment in CKD and also provides a report on extensive experience in the field of renal diets in Italy, with special attention given to approaches in clinical practice and management.
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.
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.
Bioscientia Medicina : Journal of Biomedicine and Translational Research
The need for proper nutrition and diet is fundamental in every stage of chronic kidney disease. The principle of nutritional therapy is slowing the progression of chronic kidney disease, delaying patients with CKD (chronic kidney disease) from getting kidney replacement therapy. In CKD patients, there is a disturbance of protein homeostasis, disturbance in metabolism protein, acid-base disorders, and hormonal dysfunctions. As the progression of CKD increases, nitrogen-containing products accumulate, causing a decrease in appetite. In CKD patients, intestinal absorption is also impaired because uremia causes microbiota disturbance and damage to the intestinal epithelium. These various things cause nutritional status to become often irregular, and protein energy wasting frequently occurs, thus requiring dietary adjustments in patients with CKD. In conclusion, each individual with CKD has a different nutritional therapy approach depending on the disease conditions and nutritional statu...
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...