Which low-protein diet for which CKD patient? An observational, personalized approach.

Abstract

OBJECTIVES:

Low protein diets (LPDs) are milestones in chronic kidney disease (CKD). Concerns over compliance and safety limit their use. The aim of this study was to test the feasibility and main results of a multiple-choice approach to LPDs, adapted to patient preferences.

METHODS:

From December 2007 to January 2013, all CKD patients (stages 4/5; progressive stage 3) without contraindications (malnutrition, short life expectancy), were offered two main LPDs (proteins 0.6 g/kg daily): Vegan supplemented (LPD-KA) or with "aproteic" commercial food (LPD-ACF). LPDs followed a qualitative approach based on forbidden and allowed food; one to three free meals per week, and flexible control policy (1-3 mo). Start of dialysis, death, and combined outcome (death-dialysis) were analyzed by Kaplan-Meier curves and Cox model. Comparison with dialysis in patients with glomerular filtration rate (GRF) <15 mL/min, (corresponding to "early" dialysis start) employed standardized mortality rates, with respect to the Italian and the United States Dialysis Registry.

RESULTS:

One hundred eighty-five patients (222 patient-years) started at least a trial of LPD-KA, 122 (177 patients-years) LPD-ACF; only 3 patients with GFR <30 mL/min denied an LPD trial. Patients who chose LPD-KA were younger than those on LPD-ACF (63 versus 74 y), had less comorbidity (82% versus 93%), higher proteinuria (1.4 versus 0.7 g/d) and lower GFR (17 versus 23 mL/min) (P < 0.001). Median daily protein intake was 0.7 g/kg on both diets (Maroni-Mitch formula). The combined outcome (death or dialysis) was not influenced by the diet chosen (Cox analysis). Relative risk for death on the diet (patients with GFR <15 mL/min) was 0.5 with respect to the Italian Registry and 0.3 to the United States Dialysis Registry. The diets had comparable costs (1 y on dialysis: 50 patient-years on LPD).

CONCLUSIONS:

The choice of diet is strictly linked to patient characteristics, thus supporting a multiple-choice offer. Once corrected for baseline data, both LPDs led to similar results, suggesting at least survival equivalence with dialysis, at lesser cost.

• Authors: Giorgina B Piccoli, Maria Chiara Deagostini, Federica Neve Vigotti, Martina Ferraresi, Irene Moro, Valentina Consiglio, Stefania Scognamiglio, Elena Mongilardi, Roberta Clari, Emiliano Aroasio, Elisabetta Versino, Francesco Porpiglia
• Journal: Nutrition (Burbank, Los Angeles County, Calif.) (Nutrition) Vol. 30 Issue 9 Pg. 992-9 (Sep 2014) ISSN: 1873-1244 [Electronic] United States
• PMID: 25102817 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Dietary Proteins

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Cause of Death
• Comorbidity
• Diet, Protein-Restricted
• Diet, Vegetarian
• Dietary Proteins (administration & dosage)
• Disease Progression
• Female
• Glomerular Filtration Rate
• Humans
• Male
• Middle Aged
• Patient Compliance
• Proteinuria (epidemiology)
• Renal Dialysis
• Renal Insufficiency, Chronic (diet therapy)