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Which low-protein diet for which CKD patient? An observational, personalized approach.
Nutrition. 2014 Sep; 30(9):992-9.N

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+Show Affiliations

SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy. Electronic address: Giorgina.piccoli@unito.it.SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.General Laboratory, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.Epidemiology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.Urology Department of Oncology, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

25102817

Citation

Piccoli, Giorgina B., et al. "Which Low-protein Diet for Which CKD Patient? an Observational, Personalized Approach." Nutrition (Burbank, Los Angeles County, Calif.), vol. 30, no. 9, 2014, pp. 992-9.
Piccoli GB, Deagostini MC, Vigotti FN, et al. Which low-protein diet for which CKD patient? An observational, personalized approach. Nutrition. 2014;30(9):992-9.
Piccoli, G. B., Deagostini, M. C., Vigotti, F. N., Ferraresi, M., Moro, I., Consiglio, V., Scognamiglio, S., Mongilardi, E., Clari, R., Aroasio, E., Versino, E., & Porpiglia, F. (2014). Which low-protein diet for which CKD patient? An observational, personalized approach. Nutrition (Burbank, Los Angeles County, Calif.), 30(9), 992-9. https://doi.org/10.1016/j.nut.2014.01.004
Piccoli GB, et al. Which Low-protein Diet for Which CKD Patient? an Observational, Personalized Approach. Nutrition. 2014;30(9):992-9. PubMed PMID: 25102817.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Which low-protein diet for which CKD patient? An observational, personalized approach. AU - Piccoli,Giorgina B, AU - Deagostini,Maria Chiara, AU - Vigotti,Federica Neve, AU - Ferraresi,Martina, AU - Moro,Irene, AU - Consiglio,Valentina, AU - Scognamiglio,Stefania, AU - Mongilardi,Elena, AU - Clari,Roberta, AU - Aroasio,Emiliano, AU - Versino,Elisabetta, AU - Porpiglia,Francesco, Y1 - 2014/01/25/ PY - 2013/08/28/received PY - 2013/11/17/revised PY - 2014/01/03/accepted PY - 2014/8/9/entrez PY - 2014/8/12/pubmed PY - 2015/4/8/medline KW - CKD KW - Individualised therapies KW - Low-protein diets KW - Observational study KW - Patient survival KW - Renal survival SP - 992 EP - 9 JF - Nutrition (Burbank, Los Angeles County, Calif.) JO - Nutrition VL - 30 IS - 9 N2 - 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. SN - 1873-1244 UR - https://www.unboundmedicine.com/medline/citation/25102817/Which_low_protein_diet_for_which_CKD_patient_An_observational_personalized_approach_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0899-9007(14)00043-4 DB - PRIME DP - Unbound Medicine ER -