Protein-controlled versus restricted protein versus low protein diets in managing patients with non-dialysis chronic kidney disease: a single centre experience in Australia

Abstract

Nutrition has been an important part of medical management in patients with chronic kidney disease for more than a century. Since the 1970s, due to technological advances in renal replacement therapy (RRT) such as dialysis and transplantation, the importance of nutrition intervention in non-dialysis stages has diminished. In addition, it appears that there is a lack of high-level evidence to support the use of diet therapy, in particular the use of low protein diets to slow down disease progression. However, nutrition abnormalities are known to emerge well before dialysis is required and are associated with poor outcomes post-commencing dialysis. To improve clinical outcomes it is prudent to incorporate practice research and quality audits into routine care, as part of the continuous clinical practice improvement process. This article summarises the experience of and current practices in a metropolitan tertiary teaching hospital in Sydney, Australia.

Keeping the Diet Simple and Natural in Chronic Kidney Disease: A South African-Based Dietary Infographic

“…19 Markers of inflammation and all-cause mortality have been shown to be reduced by a high dietary fiber intake which is related to its antioxidant anti-inflammatory properties and altered bacterial metabolism in the colon. 8 It is therefore recommended for patients with advanced CKD to restrict protein intake and obtain a fiber intake of 20-30 g/day. The caring for Australians with renal impairment (CARI) guideline 2013 recommends that patients with early CKD consume a diet rich in dietary fiber (Grade 2D evidence).…”

“…7 Recent studies exploring dietary patterns and its relationship to renal outcomes show some promising results which suggest that CKD diets do not need to be so restrictive. 4,8,9 Are We Overcomplicating Dietary Advice?…”

Nutrition in Renal Supportive Care: Patient‐driven and flexible

“…• Assist patients to make informed decisions, reduce food‐related anxiety and correct any misinformation leading to unnecessary dietary restrictions …”

“…• Assist patients to make informed decisions, reduce food-related anxiety and correct any misinformation leading to unnecessary dietary restrictions. 55 • Support patient choice to relax dietary restrictions, aware of the possible consequences or continue with diet restrictions for symptom or personal choice. • Provide practical advice to allow the RSC patient to 'bend the rules' (such as occasionally enjoying higher potassium fruits in moderation) to optimize nutritional management while maintaining nutritional QoL.…”

Moderate Protein Restriction in Advanced CKD: A Feasible Option in An Elderly, High-Comorbidity Population. A Stepwise Multiple-Choice System Approach

“…Likewise, Mediterranean countries, such as Italy, where low-protein diets are a part of the routine management of CKD patients, are usually thought to be favored by baseline patterns, unlike other areas of Europe, including central and northern France, where the present study was performed [25,26,27]. In these settings, as well as in the United States or Australia, the generally higher protein intake in fact makes it difficult to convince patients of the need to follow protein-restricted diets [28,29,30,31,32].…”