Nutrition in Chronic Kidney Disease—The Role of Proteins and Specific Diets

Abstract

Chronic kidney disease (CKD) is a global public health burden, needing comprehensive management for preventing and delaying the progression to advanced CKD. The role of nutritional therapy as a strategy to slow CKD progression and uremia has been recommended for more than a century. Although a consistent body of evidence suggest a benefit of protein restriction therapy, patients’ adherence and compliance have to be considered when prescribing nutritional therapy in advanced CKD patients. Therefore, these prescriptions need to be individualized since some patients may prefer to enjoy their food without restriction, despite knowing the potential importance of dietary therapy in reducing uremic manifestations, maintaining protein-energy status.

Nutritional Status, Selected Nutrients Intake and Their Relationship with the Concentration of Ghrelin and Adiponectin in Patients with Diabetic Nephropathy

“…This study confirms a high prevalence of excess body weight (especially abdominal obesity) in patients with diabetic nephropathy may complicate the treatment of chronic kidney disease, accelerate the progress and aggravate the course of CKD [1][2][3]24,27,28,30,31,[33][34][35][36][37][38][39][40][41][42][43].…”

“…Taking into account the adverse effect of excessive protein intake on the kidneys (e.g., vasodilation of afferent renal arterioles, glomerular hypertension and hyperfiltration, increased production of uremic toxins, intensification of metabolic acidosis [3,30,33] and increased albuminuria [29], it should be noted that in the study group the protein supply was slightly increased (0.84 g/kg bw/day). This result is consistent with that obtained in a study conducted in a group of predialysis female patients [43].…”

“…It should be emphasized that CKD is preventable and treatable to a large extent [1]. An important role in these processes is played by an appropriate diet, which supports treatment and prevents both obesity and malnutrition [3,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43].…”

Observational Pilot Study: A comparison of Amino Acids and Derangement of Intestinal Function between Healthy Ageing Subjects and Patients Affected by Chronic Kidney Disease in Conservative Management

“…It should therefore be borne in mind that protein intake will need to be monitored and assessed during nutritional follow-up. Indeed, studies focusing on the protein and aminoacid metabolisms frequently report high numbers of dietary non-compliance right from the start of treatment, with percentages exceeding 50% in the case of VLPD using alphakappa keto-analogues [62][63][64][65][66]. Monitoring conducted by means of dietary interviews is frequently unreliable due to the negative motivation in patients in referring the precise outcome of dietary changes in the hope of avoiding dialysis or in the inaccurate interpretation of changes made to their diet, often caused by the lack of support and assistance from family members [67].…”

Observational Pilot Study: A comparison of Amino Acids and Derangement of Intestinal Absorption between Healthy Ageing Subjects and Patients Affected by Chronic Kidney Disease in Conservative Management

“…It should therefore be borne in mind that protein intake will need to be monitored and assessed during nutritional follow-up. Indeed, studies focussing on the protein and amino-acid metabolisms frequently report high numbers of dietary non-compliance right from the start of treatment, with percentages exceeding 50% in the case of VLPD using alpha-kappa keto-analogues [62][63][64][65][66]. Monitoring conducted by means of dietary interviews is frequently unreliable due to the negative motivation in patients in referring the precise outcome of dietary changes in the hope of avoiding dialysis or in the inaccurate interpretation of changes made to their diet, often caused by the lack of support and assistance from family members [67].…”