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

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

doi:10.1016/j.nut.2014.01.004

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

Nutrition. 2014 Sep;30(9):992-9. doi: 10.1016/j.nut.2014.01.004. Epub 2014 Jan 25.

Affiliations

¹ SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy. Electronic address: Giorgina.piccoli@unito.it.
² SS Nephrology, Department of Clinical and Biological Sciences ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.
³ General Laboratory, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.
⁴ Epidemiology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.
⁵ Urology Department of Oncology, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy.

PMID: 25102817
DOI: 10.1016/j.nut.2014.01.004

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.

Keywords: CKD; Individualised therapies; Low-protein diets; Observational study; Patient survival; Renal survival.

Publication types

Evaluation Study

MeSH terms

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*

Substances

Dietary Proteins