A Low-Nitrogen Low-Phosphorus Vegan Diet for Patients with Chronic Renal Failure

Barsotti, Giovanni; Morelli, Ester; Cupisti, Adamasco; Meola, Mario; Dani, L; Giovannetti, S

doi:10.1159/000189341

Cited by 98 publications

(79 citation statements)

References 10 publications

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“…An encouraging finding is that fruits and vegetables did not induce hyperkalemia in nondiabetic individuals with mean creatinine clearance of 16.1 ml/min per 1.73 m 2 (13). In our study, plasma [K + ] did not change significantly in the fruits and vegetables group, and no patient in any group had plasma [K + ] levels .…”

Section: Discussionsupporting

confidence: 56%

“…Such diets can induce metabolic acidosis in individuals with reduced GFR, including otherwise healthy elderly persons (28). Changing from standard industrialized society diets to a low-phosphorous vegan diet improved metabolic acidosis in patients with CKD who had a mean GFR of 16.1 ml/min (13). In addition, added fruits and vegetables reduced urine NAE, consistent with reduced net endogenous acid production (28), in individuals with CKD stage 2 (eGFR, 60-89 ml/min per 1.73 m 2 ) but without metabolic acidosis (9).…”

Section: Discussionmentioning

confidence: 99%

“…Because the Kidney Disease Outcomes Quality Initiative recommends dietary alkali for patients with CKD who have metabolic acidosis and plasma total CO 2 , 22 mM (1), we thought it unethical not to offer NaHCO 3 to individuals unable to afford Na + citrate. Because fruits and vegetables improved metabolic acidosis (13) in CKD, we felt ethically comfortable randomly assigning Figure 1. | Cascade of the selection process for study patients.…”

Section: Selection Of Patients For Studymentioning

confidence: 99%

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A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate

Goraya

Simoni

et al. 2013

Clinical Journal of the American Society of Nephrology

346

277

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SummaryBackground and objectives Current guidelines recommend Na + -based alkali for CKD with metabolic acidosis and plasma total CO 2 (PTCO 2 ) , 22 mM. Because diets in industrialized societies are typically acid-producing, we compared base-producing fruits and vegetables with oral NaHCO 3 (HCO 3 ) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury.Design, setting, participants, & measurements Individuals with stage 4 (eGFR, 15-29 ml/min per 1.73 m 2 ) CKD due to hypertensive nephropathy, had a PTCO 2 level , 22 mM, and were receiving angiotensin-converting enzyme inhibition were randomly assigned to 1 year of daily oral NaHCO 3 at 1.0 mEq/kg per day (n=35) or fruits and vegetables dosed to reduce dietary acid by half (n=36).Results Plasma cystatin C-calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO 2 was higher than baseline in the HCO 3 group (21.261.3 versus 19.561.5 mM; P,0.01) and the fruits and vegetables group (19.961.7 versus 19.361.9 mM; P,0.01), consistent with improved metabolic acidosis, and was higher in the HCO 3 than the fruits and vegetable group (P,0.001). One-year urine indices of kidney injury were lower than baseline in both groups. Plasma [K + ] did not increase in either group.Conclusions One year of fruits and vegetables or NaHCO 3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO 2 , and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Selection Of Patients For Studymentioning

confidence: 99%

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A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate

Goraya

Simoni

et al. 2013

Clinical Journal of the American Society of Nephrology

346

277

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“…The VLPD (0.3-0.4 g/kg body weight/d protein) is a vegetarian diet that mainly includes vegetables and fruits and is supplemented with essential aminoacids and ketoacids (69). To maintain a neutral nitrogen balance, though the protein intake is below the minimum required threshold, ketoacids are given to allow endogenous nitrogen recycling as a means of building the essential aminoacids from the relative ketoacids, thus further contributing to reduce serum urea levels (70).…”

Section: Would a Vlpd/ketodiet Be Indicated For This Patient?mentioning

confidence: 99%

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

Bellizzi

Carrero

Chauveau

et al. 2016

Nephrology @ Point of Care

Self Cite

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This is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2 nd International Conference of the European Renal Nutrition working group at ERA-EDTA-"Retarding CKD progression: readily available through comprehensive nutritional management?"-and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections-basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD-linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD)• What nutritional assessment/monitoring for protein-energy wasting (PEW) should be employed?• Is a body mass index (BMI) of 21 kg/m 2 adequate? • What phosphate target should be pursued?• What are the nutritional habits in patients with incident CKD?• What protein needs and amount of dietary protein should be pursued?• Does the quality of protein matter?• What amount of dietary salt should be employed? How should this be obtained?• How should normal serum phosphate be achieved?• What diet should be recommended? Is a vegetarian diet an option?

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“…It has been shown that a low-protein, lowphosphorus diet protects remnant glomeruli from further sclerotic changes and delays end stage renal disease (ESRD) (Zandik et al, 1998). Thus, an appropriate diet is critically important in the management of patients with CRF, because it offers several advantages and benefits (Giovannetti and Maggmore, 1964;Giovannetti, 1985;Barsotti et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

The effects of controlled intake of selected protein foods on nephrectomized rats

Fadupin¹,

Keshinro²,

Arije³

et al. 2010

African Journal of Biomedical Research

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Dietary management of patients with chronic renal failure (CRF) has remained a very tasking one, especially as it affects the source and quantity of protein in diets. This study was carried out to determine the effects of lowprotein diets from common protein foods on 36 ⅔-nephrectomized albino rats (NR). NR were placed on isocaloric 14% protein diets incorporating cooked beef (A), smoked catfish (B), cooked beef and smoked catfish (C), cooked beef, smoked catfish and sun-dried, hulled, red cowpeas (D), cooked egg white (E), and sun-dried hulled, red cowpeas (F) for a period of six months during which food intake, anthropometric parameters, blood urea and serum creatinine levels were measured. Food intake decreased significantly (p<0.05) in the NR placed on all experimental diets, with F>A>C=D>B>E. The same trend was obtained for body weight gains. All the NR had proteinuria and reduction in 24-hour urine output; these were greatest in NR placed on diet F and lowest in those on diets E and B. Blood urea and serum creatinine levels of NR on diet E were significantly lower (p<0.05) than the corresponding levels for NR on diets B>C>A>D>F. In conclusion, this study has shown that cooked egg white and smoked catfish had more beneficial effects on food intake, anthropometric parameters, blood urea and creatinine levels in NR. It is recommended that low-protein diets containing egg white and fish be offered to patients suffering from early to moderately severe CRF as conservative therapy to ameliorate its symptoms in patients.(Afr. J. Biomed. Res. 11: 47-54)

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A Low-Nitrogen Low-Phosphorus Vegan Diet for Patients with Chronic Renal Failure

Cited by 98 publications

References 10 publications

A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate

A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

The effects of controlled intake of selected protein foods on nephrectomized rats

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