Reduction of morbidity related to emergency access to dialysis with very low protein diet supplemented with ketoacids (VLPD+KA)

Duenhas, Marta; Gonçalves, Elsa; Días, Marlene Alves; Leme, Graziela; Laranja, Sandra Maria Rodrigues

doi:10.5414/cn107460

Cited by 13 publications

(8 citation statements)

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“…The advantage was higher in younger patients, and no difference was observed considering the first year of follow-up after the start of dialysis; this observation rules out a carry-over effect of the diet, in keeping with previous observations, and in contrast with the highly debated, long-term report of the Modification of the Diet in Renal Diseases (MDRD) study [16,39,40,41,42]. …”

Section: Discussionsupporting

confidence: 83%

Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?

et al. 2016

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The indications for delaying the start of dialysis have revived interest in low-protein diets (LPDs). In this observational prospective study, we enrolled all patients with chronic kidney disease (CKD) who followed a moderately restricted LPD in 2007–2015 in a nephrology unit in Italy: 449 patients, 847 years of observation. At the start of the diet, the median glomerular filtration rate (GFR) was 20 mL/min, the median age was 70, the median Charlson Index was 7. Standardized mortality rates for the “on-diet” population were significantly lower than for patients on dialysis (United States Renal Data System (USRDS): 0.44 (0.36–0.54); Italian Dialysis Registry: 0.73 (0.59–0.88); French Dialysis Registry 0.70 (0.57–0.85)). Considering only the follow-up at low GFR (≤15 mL/min), survival remained significantly higher than in the USRDS, and was equivalent to the Italian and French registries, with an advantage in younger patients. Below the e-GFR of 15 mL/min, 50% of the patients reached a dialysis-free follow-up of ≥2 years; 25% have been dialysis-free for five years. Considering an average yearly cost of about 50,000 Euros for dialysis and 1200 Euros for the diet, and different hypotheses of “spared” dialysis years, treating 100 patients on a moderately restricted LPD would allow saving one to four million Euros. Therefore, our study suggests that in patients with advanced CKD, moderately restricted LPDs may allow prolonging dialysis-free follow-up with comparable survival to dialysis at a lower cost.

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Section: Discussionsupporting

confidence: 83%

Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?

et al. 2016

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“…[44] Delaying dialysis with LPD could also save time for maturation of arteriovenous fistula and avoid the insertion of central venous catheter. [45] Furthermore, LPD may play a role in incremental transition to dialysis therapy; once-weekly dialysis combined with LPD was found beneficial compared to thrice-weekly hemodialysis with respect to frequency of hospitalization, dose of erythropoietin, phosphorus binder, and cinacalcet therapy, without a significant difference in patient survival. [46] The importance of incremental dialysis has been revisited to preserve residual kidney function in dialysis patients, [47–51] because rapid decline in residual kidney function is associated with increased mortality.…”

Section: Conservative Management With Low Protein Diet In End-stage Rmentioning

confidence: 99%

Dietary protein intake and chronic kidney disease

Ko¹,

Obi

Tortorici

et al. 2017

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

178

119

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Purpose of review High protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration. This can cause damage to glomerular structure leading to or aggravating chronic kidney disease (CKD). Hence, a low protein diet (LPD) of 0.6–0.8 g/kg/day is often recommended for the management of CKD. We reviewed the effect of protein intake on incidence and progression of CKD and the role of LPD the CKD management. Recent findings Actual dietary protein consumption in CKD patients remain substantially higher than the recommendations for LPD. Notwithstanding the inconclusive results of the Modification of Diet in Renal Disease (MDRD) study, the largest randomized controlled trial to examine protein restriction in CKD, several prior and subsequent studies and meta-analyses including secondary analyses of the MDRD data appear to support the role of LPD on retarding progression of CKD and delaying initiation of maintenance dialysis therapy. LPD can also be used to control metabolic derangements in CKD. Supplemented LPD with essential amino acids or their keto-analogs may be used for incremental transition to dialysis especially in non-dialysis days. An LPD management in lieu of dialysis therapy can reduce costs, enhance psychological adaptation, and preserve residual renal function upon transition to dialysis. Adherence and adequate protein and energy intake should be ensured to avoid protein-energy wasting. Summary A balanced and individualized dietary approach based on LPD should be elaborated with periodic dietitian counselling and surveillance to optimize management of CKD, to assure adequate protein and energy intake and to avoid or correct protein-energy wasting.

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“…These findings strongly suggest that dietary therapy can be used to safely delay (for up to several months) the need for chronic dialysis in selected patients with pre-ESRD. LPDs or SVLPDs may also provide patients with advanced CKD with sufficient time for placement and maturation of a permanent hemodialysis vascular access or peritoneal dialysis catheter without requiring the use of temporary catheters needed to inaugurate dialysis urgently (47). Mortality increases when people commence chronic dialysis (25).…”

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

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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Reduction of morbidity related to emergency access to dialysis with very low protein diet supplemented with ketoacids (VLPD+KA)

Abstract: The VLPD+KA is safe to maintain the nutritional status of patients of CKD until the AV fistula is made or the PD training is given.

Cited by 13 publications

References 0 publications

Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?

Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?

Dietary protein intake and chronic kidney disease

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

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