Protein-restricted diets are widely used in the dietary management of
uremia. These diets are undoubtedly effective in ameliorating many aspects of the uremic syndrome. However, there is no consensus as to whether diets providing less than 0.6 g/kg per day of
protein are nutritionally adequate and capable of preventing the
wasting syndrome. Wasting is common in the adult patient with
renal insufficiency as is growth failure in the uremic child. There is some evidence that wasted patients do less well on
hemodialysis and are more prone to
infection. Experimental studies in uremic animals point ot diminihsed efficiency of utilization of
protein, increased gluconeogenesis from animo
acids, and increased catabolism of
protein in the fasting state; in addition, the metabolism of a number of individual
amino acids is altered in
uremia. In view of these
multiple abnormalities, it would seem unwise to routinely provide less than the Recommended Daily Allowances of
protein. More recent developments, i.e., supplementation of
essential amino acids and perhaps alpha
keto acids, may provide useful alternatives. One important aspect of dietary management, i.e. prevention of
hyperlipidemia, has attracted surprisingly little attention so far.
Therapy with
protein restricted diets in nondialyzed uremic patients has to compete with other modalities of treatment currently available, i.e.,
hemodialysis and
transplantation, in providing optimal medical rehabilitaiton of the patient.