Diets For Patients With Chronic Kidney Disease, Still Worth Prescribing

Mitch, William E.; Remuzzi, Guiseppe

doi:10.1097/01.asn.0000106014.20274.c7

Cited by 93 publications

(66 citation statements)

References 28 publications

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“…Low-protein diets may represent a very interesting therapeutic tool to contrast pregnancy-related hyperfiltration and reduce functional stress on remnant nephrons (46). However, experience with low-protein diets in pregnancy is limited.…”

Section: Discussionmentioning

confidence: 99%

“…This bias reflects an ethical choice to allow patients to choose their own diets during pregnancy, an issue that is shared with long-term diet treatments (46). It is important to point out that the control cohort, which mostly included stage 3 CKD patients, may present two opposite biases: a positive selection, because some patients had milder disease (only one patient had diabetic nephropathy, and baseline proteinuria was significantly lower), and a negative selection because of late referral or cultural and language barriers, often reflecting a lower sociocultural status, which is itself linked with less favorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Piccoli¹,

Leone²,

Attini

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Women affected by CKD increasingly choose to get pregnant. Experience with lowprotein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets.Design, setting, participants, & measurements This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (.1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies-21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 proteinunrestricted meals allowed per week.Results Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P,0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups.Conclusion Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Piccoli¹,

Leone²,

Attini

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Clearly, urea production reflects the level of protein in the diet and the risk of developing complications of uremia. In addition, a high-protein diet invariably contains excesses of salt, potassium, phosphates, and so forth (83). The clinical problems that arise from high-protein diets in patients with CKD were recently highlighted in reports concluding that increases in salt intake or serum phosphorus will block the beneficial influence of angiotensin-converting enzyme inhibitors to delay the progression of CKD (84,85).…”

Section: Clinical Usesmentioning

confidence: 99%

Urea and Ammonia Metabolism and the Control of Renal Nitrogen Excretion

Weiner

Mitch

Sands

2015

Clinical Journal of the American Society of Nephrology

352

265

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Renal nitrogen metabolism primarily involves urea and ammonia metabolism, and is essential to normal health. Urea is the largest circulating pool of nitrogen, excluding nitrogen in circulating proteins, and its production changes in parallel to the degradation of dietary and endogenous proteins. In addition to serving as a way to excrete nitrogen, urea transport, mediated through specific urea transport proteins, mediates a central role in the urine concentrating mechanism. Renal ammonia excretion, although often considered only in the context of acidbase homeostasis, accounts for approximately 10% of total renal nitrogen excretion under basal conditions, but can increase substantially in a variety of clinical conditions. Because renal ammonia metabolism requires intrarenal ammoniagenesis from glutamine, changes in factors regulating renal ammonia metabolism can have important effects on glutamine in addition to nitrogen balance. This review covers aspects of protein metabolism and the control of the two major molecules involved in renal nitrogen excretion: urea and ammonia. Both urea and ammonia transport can be altered by glucocorticoids and hypokalemia, two conditions that also affect protein metabolism. Clinical conditions associated with altered urine concentrating ability or water homeostasis can result in changes in urea excretion and urea transporters. Clinical conditions associated with altered ammonia excretion can have important effects on nitrogen balance.

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“…It has been more difficult to document this effect in humans. Low-protein diets may delay dialysis either through a reduction in uremic symptoms or through a specific renal protective effect (28). The MDRD study, the largest study to address this issue to date, found that a low-protein diet of 0.58 g protein/kg body wt per d compared with a usual intake of 1.3 g protein/kg body wt per d in patients with a GFR of 25 to 55 ml/min per 1.73 m 2 body surface area produced only a modest improvement in the rate of loss of GFR (18); this finding, however, has been challenged by subsequent analysis (29).…”

Section: Low-protein Dietmentioning

confidence: 99%

Angiotensin-Converting Enzyme Inhibition and Renal Protection in Nondiabetic Patients

Chiurchiu

Ruggenenti

2005

Journal of the American Society of Nephrology

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ESRD represents a major health problem. The number of patients who enter kidney replacement programs has increased at an average of 7% per year in the past 10 yr. A large number of experimental and clinical studies have demonstrated that chronic nephropathies share common pathogenic mechanisms that contribute to renal disease progression, even independent of the original cause. Clinical studies found a significant correlation between the extent of urinary protein excretion and the rate of GFR decline in both diabetic and nondiabetic chronic nephropathies. Randomized trials, in particular the Ramipril Efficacy In Nephropathy (REIN) study, also showed that treatments that reduce proteinuria (namely angiotensin-converting enzyme [ACE] inhibitors) are renoprotective and limit progression to ESRD. Meta-analyses of randomized clinical trials also evaluated the role of proteinuria and of ACE inhibition therapy in chronic renal disease progression. Their findings were consistent with those of the REIN study and confirmed in larger series of patients the predictive value of proteinuria and the renoprotective effect of proteinuria reduction by ACE inhibition therapy. Thus, the meta-analyses may confirm and extend previous findings generated by randomized clinical trials. Conceivably, well-designed studies in properly selected and carefully monitored patients who are at increased risk continue to be the best approach to test novel hypotheses. The meta-analyses, however, represent a valuable tool to evaluate the consistency and generalizability of trial results to larger cohorts of patients.

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Diets For Patients With Chronic Kidney Disease, Still Worth Prescribing

Cited by 93 publications

References 28 publications

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Urea and Ammonia Metabolism and the Control of Renal Nitrogen Excretion

Angiotensin-Converting Enzyme Inhibition and Renal Protection in Nondiabetic Patients

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