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

Walser, Mackenzie

doi:10.1159/000057352

Cited by 14 publications

(6 citation statements)

References 28 publications

(31 reference statements)

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“…It was reported that the administration of a keto acidfortified protein-restricted diet for 2-3 years in the predialysis period prevented the development of hypoalbuminemia [18].…”

Section: Discussionmentioning

confidence: 99%

The role of keto acids in the supportive treatment of children with chronic renal failure

2005

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According to the hyperfiltration theory of renal diseases characterized by a decrease in the number of functional nephrons, increased arterial blood pressure, excessive protein intake in the diet, high levels of calcium (Ca) and phosphorus (P), secondary hyperparathyroidism, hypertriglyceridemia and/or hypercholesterolemia, proteinuria and metabolic acidosis are some factors that impair the prognosis of the disease. The amount of protein in the diet is the most important of these factors. A protein-restricted diet administered to patients with chronic renal failure results in the risk of inadequate amino acid intake. To overcome this problem, the use of dysaminated alpha-keto analogues has been considered to reduce the risk of nitrogenemia resulting from the continuous intake of essential amino acids. Currently, the necessity of essential amino acids even in adult patients with chronic renal failure is controversial; besides, trials on the use of these amino acids in pediatric patients are scarce. The aim of this study is to investigate the efficacy and applicability of conservative therapy with a protein-restricted diet supplemented with keto acids in the management of chronic renal insufficiency or failure.

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“…It was reported that the administration of a keto acidfortified protein-restricted diet for 2-3 years in the predialysis period prevented the development of hypoalbuminemia [18].…”

Section: Discussionmentioning

confidence: 99%

The role of keto acids in the supportive treatment of children with chronic renal failure

2005

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“…However, substantial data indicate that LPDs and SVLPDs, when properly prescribed, do not engender protein-energy wasting (7,10). These findings raise the possibility that properly prescribed dietary therapy in patients approaching ESRD might reduce their mortality risk after they commence chronic dialysis treatment, a thesis that would seem to be well worth testing (45,46).…”

Section: Benefits and Safety Of Diets For Deferring Dialysis By Amelimentioning

confidence: 99%

“…Protein restriction at higher levels of GFR may also ameliorate more subtle uremic symptoms. Current data suggest that patients need a minimum GFR level-possibly a urea clearance $2-3 ml/min per 1.73 m 2 -to do well with dietary therapy (46). Patients being considered for dietary therapy probably should not suffer from severe acute or chronic catabolic illness, should be able to understand the dietary therapy, should Table 3.…”

Section: Future Directionsmentioning

confidence: 99%

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

Hanafusa

Lodebo

Kopple

2017

CJASN

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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.

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“…Quite the contrary, as we have indicated, without dietary therapy, the risk of advanced CKD patients developing PEW is quite high [7,8,13,35]. On the other hand, advanced CKD patients who do not have superimposed catabolic illnesses and who adhere to well-designed LPDs or SVLPDs are at low risk for developing severe PEW, and most appear to develop little or no PEW [2,9,36]. Although there are no randomized prospective controlled studies of the effect of dietary therapy in advanced CKD patients on survival.…”

mentioning

confidence: 91%

“…Although there are no randomized prospective controlled studies of the effect of dietary therapy in advanced CKD patients on survival. Several post-facto observational studies suggest that the association between mortality rate after commencing chronic dialysis treatments and prescription of SVLPDs to CKD patients is not increased mortality and may be reduced [36,37].…”

mentioning

confidence: 99%