Low Protein Diets Are Not Needed in Chronic Renal Failure

Mehrotra, Rajnish; Nolph, Karl D.

doi:10.1159/000057466

Cited by 14 publications

(10 citation statements)

References 24 publications

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“…serum phosphate levels), not hard outcomes (20 -24). Considering that phosphate-rich foods tend to be good sources of dietary protein (25,26) concern exists that long-term phosphate restriction may exacerbate protein energy malnutrition (27)(28)(29)(30), which is both common and potently associated with mortality among hemodialysis patients (31)(32)(33)(34).…”

Section: Introductionmentioning

confidence: 99%

Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients

Lynch¹,

Lynch²,

Curhan³

et al. 2011

Clinical Journal of the American Society of Nephrology

130

102

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SummaryBackground and objectives Hyperphosphatemia is common among hemodialysis patients. Although prescribed dietary phosphate restriction is a recommended therapy, little is known about the long-term effects on survival.Design, setting, participants, & measurements We conducted a post hoc analysis of data from the Hemodialysis Study (n ϭ 1751). Prescribed dietary phosphate was recorded at baseline and annually thereafter. Marginal structural proportional hazard models were fit to estimate the adjusted association between dietary phosphate restriction and mortality in the setting of time-dependent confounding.Results At baseline, prescribed daily phosphate was restricted to levels Յ870, 871 to 999, 1000, 1001 to 2000 mg, and not restricted in 300, 314, 307, 297, and 533 participants, respectively. More restrictive prescribed dietary phosphate was associated with poorer indices of nutritional status on baseline analyses and a persistently greater need for nutritional supplementation but not longitudinal changes in caloric or protein intake. On marginal structural analysis, there was a stepwise trend toward greater survival with more liberal phosphate prescription, which reached statistical significance among subjects prescribed 1001 to 2000 mg/d and those with no specified phosphate restriction: hazard ratios (95% CIs) 0.73 (0.54 to 0.97) and 0.71 (0.55 to 0.92), respectively. Subgroup analysis suggested a more pronounced survival benefit of liberal dietary phosphate prescription among nonblacks, participants without hyperphosphatemia, and those not receiving activated vitamin D.Conclusions Prescribed dietary phosphate restriction is not associated with improved survival among prevalent hemodialysis patients, and increased level of restriction may be associated with greater mortality particularly in some subgroups.

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Section: Introductionmentioning

confidence: 99%

Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients

Lynch¹,

Lynch²,

Curhan³

et al. 2011

Clinical Journal of the American Society of Nephrology

130

102

View full text Add to dashboard Cite

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“…Frequent care by nephrologists and advice by dieticians might have lead to the prevention of severe complications. However, we could not maintain blood Hb levels more than 10.0 g/dl in spite of EPO therapy and occasional supplements of iron, VB 6 , VB 12 , VC and folic acid. Blood Hb levels decreased from 10.3 B 1.8 to 8.7 B 1.6 g/dl (-13.8 B 17.1%).…”

Section: Discussionmentioning

confidence: 81%

Clinical Profiles and Outcomes of End-Stage Renal Failure Patients with Late Initiation of Renal Replacement Therapy Based on Uremic Symptoms under Intensive Renoprotective Therapies

Kaizu

Uriu²,

Inada³

et al. 2002

Am J Nephrol

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Aim: This study describes the clinical profiles and outcomes of renal failure patients with late initiation of renal replacement therapies (RRT) based on uremic symptoms under intensive treatment prior to the start of RRT (IT). Methods: Thirteen patients (male 10, female 3) with end-stage renal disease who preferred to wait for the initiation of RRT until uremic symptoms appeared regardless of serum creatinine (s-Cr) and 24-hour creatinine clearance (24-hour Ccr) were chosen. All patients received IT including a low-protein diet, antihypertensive drugs including enalapril, erythropoietin and others to prevent and manage uremic states until the initiation of RRT. Clinical findings at the initiation of RRT and the outcomes after the start of RRT were examined. Results: RRT was initiated 23.6 ± 16.9 months after IT without any complication in all patients when mild uremic symptoms appeared. Uremic symptoms, blood pressure, serum albumin, potassium, calcium and urinary Cr excretion were well controlled except inorganic phosphate, hemoglobin and cardiac size. 24-hour Ccr and s-Cr were 3.4 ± 0.7 ml/min and 17.4 ± 3.8 mg/dl at initiation of RRT. The outcomes of all the patients were all well during chronic RRT. Conclusion: Intensive treatment prior to the start of RRT can diminish uremic symptoms and complications so that RRT might be initiated safely and with fewer problems, even in the face of lower 24-hour Ccr and markedly higher s-Cr.

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“…Although dietary protein restriction has been advocated to slow down the progression of renal failure in diabetic patients (31), its benefit has to be weighted against its potential harm. Other studies have suggested that severe dietary protein restriction in overt DMN does not delay the progression of renal disease, but may actually induce malnutrition (32,33). The effect of protein restriction is also equivocal in non-diabetic renal patients (34).…”

Section: Malnutritionmentioning

confidence: 99%

Predialysis Care in Diabetic Patients: The Missing Link?

Wong

2003

Int J Artif Organs

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Management of type 2 diabetic nephropathy (DMN) was once considered the sole responsibility of endocrinologists. In the early years, patients who suffered from DMN either died prematurely due to cardiovascular complications, or from concurrent advanced diabetesrelated end-organ damage. As a result of the high morbidity and mortality and the poor quality of life, these patients were less likely to be advised dialysis treatment when they reached end-stage renal disease (ESRD).With the advancement in management of cardiovascular diseases and the knowledge on the importance of metabolic control, better survival of diabetic patients is achieved. Many diabetic patients develop ESRD during the course of their disease. Diabetic nephropathy has become the fastest growing segment of ESRD worldwide. As more diabetic patients are recruited into the dialysis program, the nephrologists are left with the challenge to deal with multiple comorbidity and physical dysfunction associated with diabetes mellitus, in addition to treatment of the uremic state. Despite rigorous effort in the management of cardiovascular complications and advances in dialysis therapy, and to the frustration of the healthcare workers, diabetic patients still fare poorly in terms of survival and quality of life (1-3). The burden being imposed on the healthcare system is also enormous (4). Predialysis management in diabetic patients with chronic renal insufficiency (CRI)While endocrinologists tend to focus on the management of early diabetes mellitus and the prevention of diabetes-related complications, nephrologists tend to focus mainly on the dialysis aspect of therapy. The "predialysis period", the "no-man's land", is considered to be merely a period for "dialysis planning". In reality, the progression of CRI to ESRD is a continuum of disease and the pre-dialysis period is actually a very critical period that deserves more proper attention if the outcome of dialysis is to be improved. Unfortunately, the importance of pre-dialysis care of diabetic patients is often, if not always, neglected and habitually inadequate (5). This is further aggravated by the problems of late referrals and diagnosis. Multiple comorbidity conditions of diabetic patients are often blamed as the reason for their unfavorable outcome despite optimization of the dialysis therapy. In fact, many of these complications are seen early before the commencement of any dialysis treatment. As a matter of fact, the pre-dialytic period is the most vulnerable period for the development of malnutrition, left ventricular hypertrophy (LVH), uncontrolled blood pressure, hypo-or hyperglycemia, acidosis and calcium/phosphate disturbances. Abundant data now suggest that baseline parameters at the onset of dialysis do bear a prognostic role in the outcome of dialysis therapy (5-7). This situation is especially true in the diabetic populations since such patients are prone to comorbidity conditions. The latter, once developed, usually run a relentless course.The artificial segregation of patients from a...

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Low Protein Diets Are Not Needed in Chronic Renal Failure

Cited by 14 publications

References 24 publications

Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients

Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients

Clinical Profiles and Outcomes of End-Stage Renal Failure Patients with Late Initiation of Renal Replacement Therapy Based on Uremic Symptoms under Intensive Renoprotective Therapies

Predialysis Care in Diabetic Patients: The Missing Link?

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