A practical approach to low protein diets in Sweden– 45 years of clinical use

Eyre, Sintra; Faxén‐Irving, Gerd; Attman, Per‐Ola; Evans, Marie; Windahl, Karin; Wegener, Sigrid; Andersen, Charlotte Uggerhøj; Nykvist-Raanaes, Karin; Einemo, Sara; Carrero, Juan-Jesús

doi:10.1186/s12882-016-0295-6

Cited by 4 publications

(2 citation statements)

References 14 publications

(17 reference statements)

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“…The European and Asian experiences are remarkably positive, both with low- and very low-protein regimens, even for prolonged periods of time [26, 35]. …”

Section: Low-protein Diets Are Feasiblementioning

confidence: 99%

‘Let food be thy medicine…’: lessons from low-protein diets from around the world

Piccoli

Cupisti

2017

BMC Nephrol

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In this editorial we present the special issue dedicated to low-protein diets (LPDs) in chronic kidney disease, from a global perspective.The experiences gathered from several countries across all continents have created an issue which we hope you will find insightful, and lead to further discussion on this interesting topic.We discover that LPDs are feasible in both developed and low income countries, in patients where literacy is an issue, and are also safe, including during pregnancy and in old age.Patients prescribed a low protein diet are more inclined to follow and adhere to this change in lifestyle, provided the diet has been adapted to meet their own individual needs. With an increasing list of different menu options and better medical advice being offered we no longer need to identify low protein diets with a specific menu, ingredient or supplement, or with a specific level of protein restriction. Evidence shows how the best diet is often the one chosen by the patients, which doesn’t drastically affect their day-to-day life, and delays the start of dialysis for as long as is safe under careful clinical control. The colourful menus gathered from all over the world remind us that a low protein diet does not necessarily mean that the pleasure of preparing a delicious meal is lost. The final comment is therefore dedicated to our patients: low protein diets can be beautiful.

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“…The European and Asian experiences are remarkably positive, both with low- and very low-protein regimens, even for prolonged periods of time [26, 35]. …”

Section: Low-protein Diets Are Feasiblementioning

confidence: 99%

‘Let food be thy medicine…’: lessons from low-protein diets from around the world

Piccoli

Cupisti

2017

BMC Nephrol

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“…To date, the limited availability of dialysis in developing countries and the grim prognosis of patients who start dialysis in developed countries make prolonging dialysis-free survival a major achievement for developed as well as developing countries [4,5,6,7,8,9,10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?

et al. 2016

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The indications for delaying the start of dialysis have revived interest in low-protein diets (LPDs). In this observational prospective study, we enrolled all patients with chronic kidney disease (CKD) who followed a moderately restricted LPD in 2007–2015 in a nephrology unit in Italy: 449 patients, 847 years of observation. At the start of the diet, the median glomerular filtration rate (GFR) was 20 mL/min, the median age was 70, the median Charlson Index was 7. Standardized mortality rates for the “on-diet” population were significantly lower than for patients on dialysis (United States Renal Data System (USRDS): 0.44 (0.36–0.54); Italian Dialysis Registry: 0.73 (0.59–0.88); French Dialysis Registry 0.70 (0.57–0.85)). Considering only the follow-up at low GFR (≤15 mL/min), survival remained significantly higher than in the USRDS, and was equivalent to the Italian and French registries, with an advantage in younger patients. Below the e-GFR of 15 mL/min, 50% of the patients reached a dialysis-free follow-up of ≥2 years; 25% have been dialysis-free for five years. Considering an average yearly cost of about 50,000 Euros for dialysis and 1200 Euros for the diet, and different hypotheses of “spared” dialysis years, treating 100 patients on a moderately restricted LPD would allow saving one to four million Euros. Therefore, our study suggests that in patients with advanced CKD, moderately restricted LPDs may allow prolonging dialysis-free follow-up with comparable survival to dialysis at a lower cost.

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The safety of a low-protein diet in older adults with advanced chronic kidney disease

Windahl,

Chesnaye,

Irving

et al. 2024

Nephrology Dialysis Transplantation

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Background A low protein diet (LPD) is recommended to patients with advanced chronic kidney disease (CKD), whereas geriatric guidelines recommend a higher amount of protein. The aim of this study was to evaluate the safety of LPD treatment in older adults with advanced CKD. Methods The EQUAL study is a prospective, observational study, including patients ≥65 years, incident estimated glomerular filtration rate <20 ml/min/1.73m², in six European countries with follow-up up till six years. Nutritional status was assessed by 7-point subjective global assessment (SGA) every 3-6 months. Prescribed diet (gram protein/kilogram/bodyweight) was recorded on every study visit; measured protein intake was available in three countries. Time to death and decline in nutritional status (SGA decrease by ≥2 points) were analysed using marginal structural models with dynamic inverse probability of treatment and censoring weights. Results Out of 1738 adults (631 prescribed LPD at any point during follow-up) there were 1319 with repeated SGA measurements of which 267 (20%) declined in SGA ≥ 2 points and 565 (32.5%) died. There was no difference in survival or decline in nutritional status for patients prescribed LPD ≤0.8 g/kg ideal bodyweight (Odds Ratio (OR) for mortality 1.15 (95% Confidence interval (CI) 0.86-1.55) and OR for decline in SGA 1.11 (95% CI 0.74-1.66) in the adjusted models. In patients prescribed LPD <0.6 g/kg ideal bodyweight, the results were similar. There was a significant interaction with LPD and higher age >75 years, lower SGA, and higher comorbidity burden for both mortality and nutritional status decline. Conclusions In older adults with CKD approaching end-stage kidney disease, a traditional LPD prescribed and monitored according to routine clinical practice in Europe appears to be safe.

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A practical approach to low protein diets in Sweden– 45 years of clinical use

Cited by 4 publications

References 14 publications

‘Let food be thy medicine…’: lessons from low-protein diets from around the world

‘Let food be thy medicine…’: lessons from low-protein diets from around the world

Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?

The safety of a low-protein diet in older adults with advanced chronic kidney disease

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