Protein Intake in Patients with Renal Failure: Comments on the Current NKF-DOQI Guidelines for Nutrition in Chronic Renal Failure (original) (raw)
Related papers
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.
DOQI guidelines for nutrition in long-term peritoneal dialysis patients: A dissenting view
American Journal of Kidney Diseases, 2001
The DOQI guidelines recommend a dietary protein intake of 1.2 to 1.3 g/kg/d in long-term peritoneal dialysis patients. A quantitative analysis of the relationship between this high protein intake and phosphorus intake shows that this daily load of protein is likely to lead to hyperphosphatemia in anuric patients with borderline dialysate clearance. Currently available phosphorus binders are not efficient enough to offset completely the adverse effects of a phosphorus-rich diet. An inverse correlation has been shown between serum phosphorus and outcome among dialysis patients, probably mediated by an increase in the Ca ؋ P product. Evidence, theoretic or experimental, that such a high protein intake is by itself beneficial to dialysis patients is lacking. Because high protein intake may increase the daily load of phosphorus and predispose to hyperphosphatemia, it may lead to harmful consequences, and it should be modified. Using the general recommendation for normal subjects plus the usual excessive nitrogen loss during peritoneal dialysis, between 0.9 and 1 g/kg/d most likely would be an appropriate protein intake without exposing the patient to excessive phosphorus load.
Getting to the Meat of the Matter: Beyond Protein Supplementation in Maintenance Dialysis
Seminars in Dialysis, 2009
Until recently, patients on dialysis with low serum albumin levels were characterized as suffering from protein malnutrition suggesting that the cause of this malady was due to an inadequate intake of protein. In fact, these patients tend to suffer from a wasting syndrome similar to cachexia commonly associated with inflammation in which there is loss of lean body mass and fat mass is underutilized. The term protein energy wasting has been used to characterize this syndrome and suggests that the simple addition of protein supplements to the dietary regimen of hemodialysis patients will not cure this malady. Correction of the underlying inflammatory disorder which drives losses of body protein and fuel reserves is far more important and is the single most effective therapy. Protein
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.
Is Dietary Protein Intake Predictive of 1-Year Mortality in Dialysis Patients?
The American journal of the medical sciences, 2018
High mortality in dialysis patients may be associated with protein-energy wasting (PEW) syndrome characterized by progressively depleted protein and energy stores. While early diagnosis and treatment of PEW can reduce mortality, clinically practical measures for its detection are lacking. Poor dietary protein intake (DPI) is associated with risk of malnutrition and PEW. However, the impact of DPI on mortality is unclear. The purpose of this study is to examine the ability of DPI to predict 1-year mortality in dialysis patients. This prospective, secondary study using data from the Comprehensive Dialysis Study and United States Renal Data System examined risk factors associated with 1-year mortality in dialysis patients. Seventeen (7.5%) of the 227 subjects died within 1 year following baseline data collection. One year survivors were significantly younger (60 ± 13.6 versus 71 ± 12.8; P = 0.0043), had a lower Charlson Comorbidity Index score (1.6 ± 2.3 versus 4.0 ± 3.6; P = 0.0157), ...
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...
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 2015
The normalized protein catabolic rate (nPCR) reflects daily dietary protein intake in stable dialysis patients. In peritoneal dialysis (PD) patients, reports about the importance of nPCR as marker of nutrition and outcome have been inconsistent. The objective of the present study was to investigate the relationships of nPCR with body composition parameters, micronutrient electrolytes, and long-term survival in PD patients. From November 2000 to May 2008, 57 PD patients were enrolled in the study. On enrollment, demographic, clinical, and biochemical data were recorded. Patients were followed through September 2011. Mean age of the patients was 56 years, and 61% were of African descent. Mean and maximum follow-up were 2.83 years and 11 years respectively. Mean daily nPCR was 0.944 g/kg. The nPCR correlated directly with albumin (r = 0.34, p = 0.012), magnesium (r = 0.48, p < 0.0001), phosphorus (r = 0.42, p = 0.02), and the phase angle body composition parameter (r = 0.26, p = 0.0...
Are oral protein supplements helpful in the management of malnutrition in dialysis patients?
Indian Journal of Nephrology, 2013
study was carried out to look for the effect of the two oral formulae supplements on nutritional parameters in dialysis population. Materials and Methods All adult patients on hemodialysis and peritoneal dialysis were eligible for the study. The total number of patients to be studied was 50, randomly divided into 25 patients to get whey protein and 25 to get egg albumin supplement. Both these proteins were commercially available with 100 gm of whey powder containing 46 g protein and 230 Kcal energy, and egg albumin powder containing 70 g protein and 316 Kcal energy per 100 gram. Patients, who were on thrice a week hemodialysis or more than 3 exchanges per day of peritoneal dialysis were included. Adequacy of hemodialysis was observed by urea reduction ratio (URR) every month, and for peritoneal dialysis by KT/V urea every 6 months. Vegetarians were excluded because randomization was between whey protein and egg protein. Patients with active infection in last four weeks, hepatitis B, hepatitis C, or HIV infection were also excluded. Patient enrolment was done on first come first basis after fulfilling the inclusion and exclusion criteria. After consent, at the enrolment, daily dietary intake of calories and proteins was calculated from
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...