Current Uses of Dietary Therapy for Patients with Far-Advanced CKD

Abstract

For several decades, inquiry concerning dietary therapy for nondialyzed patients with CKD has focused mainly on its capability to retard progression of CKD. However, several studies published in recent years indicate that, independent of whether diet can delay progression of CKD, well designed low-protein diets may provide a number of benefits for people with advanced CKD who are close to requiring or actually in need of RRT. Dietary therapy may both maintain good nutritional status and safely delay the need for chronic dialysis in such patients, offering the possibility of improving quality of life and reducing health care costs. With the growing interest in incremental dialysis, dietary therapy may enable lower doses of dialysis to be safely and effectively used, even as GFR continues to decrease. Such combinations of dietary and incremental dialysis therapy might slow the rate of loss of residual GFR, possibly reduce mortality in patients with advanced CKD, improve quality of life, and also, reduce health care costs. The amount of evidence that supports these possibilities is limited, and more well designed, randomized clinical trials are clearly indicated.

Nutritional treatment of advanced CKD: twenty consensus statements

“…When correctly carried out with an adequate energy intake, it does not have negative effects upon the nutritional state and survival rate, both during the CKD phase and after the start of dialysis [ 25 , 26 ]. The good metabolic control attained with nutritional treatment, enables postponement of the start of renal replacement therapy to a more advanced stage of the illness with no risk to the patient [ 27 , 28 ].…”

“…Indications for DNT include the existence of metabolic and hydroelectrolytic alterations or metabolic acidosis, protein-energy depletion or obesity, signs and symptoms of uremic intoxication, and the desire or necessity to delay the start of replacement therapy (dialysis or transplant) [ 24 , 28 , 70 ]. Contraindications include the patient’s refusal or inability to follow dietary rules due to socio-economic or psychological distress, a chewing disorder, lack of motivation, deterioration in the quality of life, etc.…”

“…DNT in IPD could reduce possible occurrence of uremic symptoms, improve metabolic control, and contribute to a delay in RRF decline. The main problems could be poor tolerance or adherence to DNT or risk of worsening nutritional status and it therefore would require periodic metabolic and anthropometric checkups [ 28 ]. In Brescia, an IPD experiment began in 2002.…”

Low Protein Diets and Plant-Based Low Protein Diets: Do They Meet Protein Requirements of Patients with Chronic Kidney Disease?

“…N balance was directly related to energy intake, with an intake providing approximately 35 kcal/kg/day more likely to maintain a neutral or positive N balance. Thus, an adequate energy supply is an important aspect of nutritional treatment in CKD [ 50 ].…”

Ready to Change: Attitudes of an Elderly CKD Stage 3–5 Population towards Testing Protein-Free Food

“…Slowing the progression of renal damage becomes crucial in earlier phases, while metabolic stabilization in late CKD phases sometimes makes it possible to postpone dialysis. For this purpose, nutritional management, in particular protein restriction, plays a role in protecting kidney function [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. In fact, the new guidelines of the Kidney Disease Outcomes Quality Initiative (K-DOQI) suggest protein restriction should be introduced early, when possible in stage three, with a profile adapted to each patient, provided that the patients are metabolically stable and free from acute diseases—especially if these diseases potentially induce wasting [ 17 ].…”