Dietary Treatment of Chronic Renal Failure: Why Is It Not Used More Frequently?

The main purpose of our study was to verify the effect of a very-low-protein, low-phosphorus diet, supplemented with essential amino acids and keto analogues and with calcium carbonate, on circulating levels of intact parathyroid hormone (i-PTH) in severe chronic renal failure patients with secondary hyperparathyroidism, not treated with any vitamin D preparation. To this aim, we shifted 21 chronic uremics (12 males, 9 females; age 56 ± 13 years) with serum creatinine >6.5 mg/dl and i-PTH >150 pg/ml, from a standard low-protein diet (0.6 g/kg/day approximately) to a very-low-protein (0.3 g/kg/day), very-low-phosphorus (5 mg/kg/day) diet supplemented with a mixture of essential amino acids and calcium keto analogues (Ketodiet), calcium carbonate (2–4 g/day), iron, and vitamin B₁₂ preparations. The energy supply of both diets was 30–35 kcal/kg/day. Exclusion criteria were a poor compliance with dietary or supplement prescriptions or signs of autonomic hyperparathyroidism. After 4 ± 2 months of Ketodiet, the i-PTH serum levels decreased by 49% as a mean (from 441 ± 233 to 225 ± 161 pg/ml, p < 0.001); serum phosphorus and alkaline phosphatase decreased, whereas serum calcium increased. The great reduction of serum and urinary urea demonstrated a good compliance with Ketodiet, and no sign of protein malnutrition was observed. These findings confirm that even in severe chronic uremic patients dietary phosphorus restriction and calcium carbonate supplementation lower i-PTH serum levels. This is one of the goals of the dietary treatment that can be safely achieved, provided good compliance both with the dietary prescriptions and with adequate energy and supplement intakes.

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“…Thereby strong motivation and involvement are needed both by the patients and by the physicians. Unfortunately this does not always occur [12]. …”

Section: Discussionmentioning

confidence: 99%

Secondary Hyperparathyroidism in Severe Chronic Renal Failure Is Corrected by Very-Low Dietary Phosphate Intake and Calcium Carbonate Supplementation

Barsotti

Cupisti

Morelli

et al. 1998

Nephron

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“…In order to ensure adequate supply of essential amino acids, Giovannetti (1985) and Wilkins (1996) recommended up to 60-75% of the protein needs from protein of high biological value for patients with CRF or other renal diseases which should be in the form of egg, meat, fish and poultry. However, Newburg and Curtis (1928) observed that rats fed diets with dry liver as a source of protein developed renal lesion faster than when an equivalent amount of casein protein was fed to a similar group of rats; whereas a diet of beef containing equivalent amount of protein to liver or casein was neither as damaging as the liver alone diet or as agreeable as the casein diet.…”

Section: Discussionmentioning

confidence: 99%

“…Diet therapy also ameliorates uraemic toxicity over a long period of time. It provides a temporary stabilization and occasionally an improvement, in renal function for months or even years (Giodiano, 1982, Giovannetti, 1985Zandik et al, 1998). 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).…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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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“…Why this is not done with greater consistency remains a mystery. Some of the reasons are discussed by Giovannetti [4]. It also seems axiomatic that studies of patients with severe chronic renal failure should not include treatment groups that receive normal protein-containing diets as they progress towards dialysis.…”

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confidence: 99%

Effects of a Supplemented Very Low Protein Diet in Predialysis Patients on the Serum Albumin Level, Proteinuria, and Subsequent Survival on Dialysis

Walser¹

1997

Mineral Electrolyte Metab

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A very low protein diet (0.3 g/kg ideal body weight) supplemented with essential amino acids (or ketoanalogues) is seldom employed at present in chronic renal failure for fear of inducing protein deficiency, especially in patients who also have the nephrotic syndrome. Nevertheless, we have used this dietary regimen in predialysis patients for a number of years. We have shown that when these patients reach the end stage, they rarely exhibit hypoalbuminemia, in contrast to the reported 25–50% hypoalbuminemia at the onset of dialysis nationwide. Furthermore, their survival for the first 2 years on dialysis is much improved, in comparison with the national experience, adjusted for age, sex, and cause of renal disease. When nephrotic patients are given this regimen, they exhibit some improvement in parameters of the nephrotic state, but nevertheless progress to dialysis, provided their initial glomerular filtration rate (GFR) is <30 ml/min. However, if their initial GFR is >30 ml/min, they may show gradual but complete remission of the nephrotic syndrome, even when the underlying disease is diabetic nephropathy or focal segmental glomerulosclerosis. We conclude that this dietary regimen is not only safe in patients with renal failure, with or without the nephrotic syndrome, but may be of substantial benefit. The mechanism remains to be explained.

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Dietary Treatment of Chronic Renal Failure: Why Is It Not Used More Frequently?

Cited by 44 publications

References 20 publications

Secondary Hyperparathyroidism in Severe Chronic Renal Failure Is Corrected by Very-Low Dietary Phosphate Intake and Calcium Carbonate Supplementation

Secondary Hyperparathyroidism in Severe Chronic Renal Failure Is Corrected by Very-Low Dietary Phosphate Intake and Calcium Carbonate Supplementation

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

Effects of a Supplemented Very Low Protein Diet in Predialysis Patients on the Serum Albumin Level, Proteinuria, and Subsequent Survival on Dialysis

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