Dietary Protein Restriction for Renal Patients: Don't Forget Protein-Free Foods

Rossi, Andrea; Innocenti, Maurizio; Ricchiuti, Guido; Bozzoli, Laura; Sbragia, G.; Meola, Mario; Cupisti, Adamasco

doi:10.1053/j.jrn.2012.12.006

Cited by 37 publications

(34 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A low protein diet (LPD) supplying 0.6 g of proteins per Kg of body weight is enough to cover protein needs provided that there is an adequate amount of foods rich in high biological value protein (meat, fish and white egg in particular), and an adequate energy intake. For this reason the use of protein-free products was generally recommended as they represent a source of energy without wasting products [14]. …”

Section: Methodsmentioning

confidence: 99%

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundDietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care.MethodsThis is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG). In the NTG patients the dietary interventions were assigned in order to prevent or correct abnormalities and to maintain a good nutritional status. They included manipulation of sodium, phosphate, energy and protein dietary intakes while paying special attention to each patient’s dietary habits.ResultsPhosphate and BUN levels were lower in the NTG than in the CG, especially in stage 4 and 5. The prevalence of hyperphosphatemia was lower in the NTG than in CG in stage 5 (13.3 % vs 53.3 %, p < 001, respectively), in stage 4 (4.1 % vs 18.3 % vs, p < 0.001) and stage 3b (2.8 % vs 9.5 % p < 0.05). Serum albumin was higher in NTG than in CG especially in stage 5 . The use of calcium-free intestinal phosphate binders was significantly lower in NTG than in CG (11 % vs 19 % p < 0.01), as well as that of Erythropoiesis stimulating agents (11 % vs 19 %, p < 0.01), and active Vitamin D preparations (13 % vs 21 %, p < 0.01).ConclusionsThis case-control study shows the usefulness of a nutritional support in addition to the pharmacological good practice in CKD patients on tertiary care. Lower phosphate and BUN levels are obtained together with maintenance of serum albumin levels. In addition, a lower need of erythropoiesis stimulating agents, phosphate binders and active Vitamin D preparations was detected in NTG. This study suggests that a nutritional support may be useful in the management of the world-wide growing CKD burden.

show abstract

Section: Methodsmentioning

confidence: 99%

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…In Italy, 'proteinfree products' have played a fundamental role in the nutritional management of CKD patients [2], helping to reduce the CKD progression and controlling some complications of CKD [5,7]. Protein-free foods providing high energy are also useful in CKD patients with diabetes, in whom they do not have a significant impact on glycemic control, and in frail or elderly patients; indeed, the high energy intake is currently considered of paramount importance in a nutritional approach to CKD to avoid protein wasting.…”

Section: Indications For and Initiation Of Nt (Table 2)mentioning

confidence: 99%

“…Therefore, low-protein diets have been considered a cornerstone of conservative treatment for CKD [1]. On the other hand, the reduction of protein intake in CKD has raised some concern since it exposes patients to an increased risk of protein-energy wasting [2]. In this regard, the so-called 'protein-free' food products enable to add to a low-protein diet considerable amounts of energy that help to preserve the nutritional status, thus representing an important plus for the low-protein diets; these products, however, are available only in a few countries and this may limit the penetration of low-protein diets [2].…”

Section: Introductionmentioning

confidence: 99%

A Delphi consensus panel on nutritional therapy in chronic kidney disease

et al. 2016

Self Cite

View full text Add to dashboard Cite

The conservative management of chronic kidney disease (CKD) includes nutritional therapy (NT) with the aim to reduce the intake of proteins, phosphorus, organic acids, sodium, and potassium, while ensuring adequate caloric intake. While there is evidence that NT may help to prevent and control metabolic alterations in CKD, the criteria for implementing a low-protein regimen in CKD are still debated. There is no final consensus on the composition of the diet, nor indications for specific patient settings or different stages of CKD. Also when and how to start dietary manipulation of different nutrients in CKD is not well defined. A group of Italian nephrologists participated, under the auspices of the Italian Society of Nephrology, in a Delphi exercise to explore the consensus on some open questions regarding the nutritional treatment in CKD in Italy, generating a consensus opinion for 23 statements on: (1) general principles of NT; (2) indications for and initiation of NT; (3) role of protein-free products; (4) NT safety; (5) integrated management of NT. This Delphi exercise shows that there is broad consensus regarding NT in CKD across a wide range of management areas. These clinician-led consensus statements provide a framework for appropriate guidance on NT in patients with CKD, and are intended as a guide in decision-making whenever possible.

show abstract

“…In order to satisfy the increased energy requirement, it is mandatory that the recommendation of increasing exercise and physical activities are also accompanied by the recommendation to increase energy intake. In the CKD patients on low protein regimens, the energy needs can be obtained by increasing the intake of protein-free foods which provide carbohydrates and are almost free of protein, phosphorus, potassium or sodium [32]. These protein-free products represent a real “green power fuel” for CKD patients.…”

Section: Exercisementioning

confidence: 99%

Nutrition and Physical Activity in CKD patients

Cupisti¹,

Fumagalli²,

Vigo³

et al. 2014

Kidney Blood Press Res

Self Cite

View full text Add to dashboard Cite

Chronic kidney disease (CKD) patients are at risk for protein-energy wasting, abnormal body composition and impaired physical capacity. These complications lead to increased risk of hospitalization, morbidity and mortality.In CKD patient as well as in healthy people, there is a close association between nutrition and physical activity. Namely, inadequate nutrient (energy) intake impairs physical performance thus favoring a sedentary lifestyle: this further contributes to loss of muscle strength and mass, which limit the quality of life and rehabilitation of CKD patients. In CKD as well as in end-stage-renal-disease patients, regular physical activity coupled with adequate energy and protein intake counteracts protein-energy wasting and related comorbidity and mortality. In summary, exercise training can positively influence nutritional status and the perception of well-being of CKD patients and may facilitate the anabolic effects of nutritional interventions.

show abstract

Dietary Protein Restriction for Renal Patients: Don't Forget Protein-Free Foods

Cited by 37 publications

References 11 publications

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach

A Delphi consensus panel on nutritional therapy in chronic kidney disease

Nutrition and Physical Activity in CKD patients

Contact Info

Product

Resources

About