Selective effect of low protein diets in chronic renal diseases.

Nahas, A. Meguid El; Masters-Thomas, Anne; Brady, S. A.; Farrington, Kenneth; Wilkinson, Victoria L.; Hilson, A. J.W.; Varghese, Z.; Moorheàd, J. F.

doi:10.1136/bmj.289.6455.1337

Cited by 111 publications

(34 citation statements)

References 20 publications

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“…22,23 Different therapeutic strategies can reduce albuminuria, including a low-protein diet, 24 indomethacin, 25 and antihypertensive agents such as ACEIs 26 and AIIAs. 27 It is of interest to determine whether these or other interventions for the reduction of albuminuria also afford cardiac protection.…”

Section: Discussionmentioning

confidence: 99%

Albuminuria, a Therapeutic Target for Cardiovascular Protection in Type 2 Diabetic Patients With Nephropathy

et al. 2004

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Background-Albuminuria is an established risk marker for both cardiovascular and renal outcomes. Albuminuria can be reduced with drugs that block the renin-angiotensin system (RAS). We questioned whether the short-term drug-induced change in albuminuria would predict the long-term cardioprotective efficacy of RAS intervention. Methods and Results-We analyzed data from Reduction in Endpoints in Non-insulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL), a double-blind, randomized trial in 1513 type 2 diabetic patients with nephropathy, focusing on the relationship between the prespecified cardiovascular end point (composite) or hospitalization for heart failure and baseline or reduction in albuminuria. Patients with high baseline albuminuria (Ն3 g/g creatinine) had a 1.92-fold (95% CI, 1.54 to 2.38) higher risk for the cardiovascular end point and a 2.70-fold (95% CI, 1.94 to 3.75) higher risk for heart failure compared with patients with low albuminuria (Ͻ1.5 g/g). Among all available baseline risk markers, albuminuria was the strongest predictor of cardiovascular outcome. The association between albuminuria and cardiovascular outcome was driven by those patients who also had a renal event.Modeling of the initial 6-month change in risk parameters showed that albuminuria reduction was the only predictor for cardiovascular outcome: 18% reduction in cardiovascular risk for every 50% reduction in albuminuria and a 27% reduction in heart failure risk for every 50% reduction in albuminuria. Conclusions-Albuminuria is an important factor predicting cardiovascular risk in patients with type 2 diabetic nephropathy. Reducing albuminuria in the first 6 months appears to afford cardiovascular protection in these patients.

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Section: Discussionmentioning

confidence: 99%

Albuminuria, a Therapeutic Target for Cardiovascular Protection in Type 2 Diabetic Patients With Nephropathy

et al. 2004

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“…As to nonpharmacologic intervention, data indicate that a low-protein diet lowers proteinuria and reduces the rate of renal function loss (33). In an interesting parallel to pharmacologic intervention, the amount of initial proteinuria reduction induced by the diet is correlated with the degree of subsequent renal function loss.…”

Section: Antiproteinuric Properties Count: Another Strategy?mentioning

confidence: 86%

Renoprotection

Vogt

Navis²,

Zeeuw

2002

Journal of the American Society of Nephrology

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Abstract. Data from recent clinical trials show that lowering of BP reduces the rate of renal function loss in chronic renal disease. There is evidence supporting the assertion that BP lowering obtained by intervention in the renin-angiotensinaldosterone system (RAAS) has an additive renoprotective effect in both diabetic and nondiabetic renal diseases. However, to dissociate BP-dependent and non-BP-dependent action of RAAS blockade, the relevant trials are in many cases flawed by design, resulting in BP differences between the comparative antihypertensive strategies. This review discusses whether the relevant literature allows for the conclusion that RAAS intervention has renoprotective effects in addition to its effects on BP. In particular, the main evidence for a specific renoprotective action of RAAS blockade is provided by its consistent antiproteinuric action, which cannot completely be attributed to the reduction in BP. Indeed, other strategies that lower proteinuria without having an antihypertensive effect, such as lowering dietary protein intake or the use of nonsteroidal antiinflammatory drugs, appear to have a renoprotective effect as well. Interestingly, a consistent finding across different intervention studies is that the more proteinuria is reduced the better the kidney appears to be protected. Therefore, it is concluded that agent-characteristics of RAAS intervention (i.e., antiproteinuric properties) independently influence renal function loss in addition to its BP-lowering effect. Future studies should further explore the renoprotective benefit of non-antihypertensive intervention measures, alone and in combination with antihypertensive strategies.Antihypertensive therapy has always been the cornerstone of renoprotective intervention. Recent large trials particularly indicate that intervention in the renin-angiotensin-aldosterone system (RAAS) appears to be effective in retarding the decline of renal function loss in both diabetic and nondiabetic renal diseases. In nondiabetic patients, the AIPRI (1) and REIN (2) studies showed that angiotensin-converting enzyme (ACE) inhibitors delay the progression of renal function loss. Lewis et al. (3) showed a renoprotective effect of ACE inhibitors in type 1 diabetic patients. Moreover, two recent studies, RENAAL (4) and IDNT (5), demonstrated angiotensin-II (AngII)-receptor (type 1) antagonists to be renoprotective in type 2 diabetics.The above-mentioned trials, comprising thousands of patients, can be taken as impressive evidence for RAAS intervention to be superior to other treatment strategies. However, whether the effects of RAAS intervention are due to the specific pharmacologic RAAS blockade as such or due to their antihypertensive potency is a crucial question. This issue is still open, because in many of the above trials, the obtained BP levels were lower in the patients treated with an agent that intervenes in the RAAS compared with the control groups. The current review focuses on this particular question, that is, is renoprotection obtain...

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“…We used a regimen of low protein diet, with high biologic value in our protocol. The use of low protein diet, high biologic value proteins, and special formula, is one of the methods that could potentially alleviate the need for RRT in predialysis state (4)(5)(6). Low protein diet with the addition of Acacia gum (1 g/kg/day) is another regimen that has recently been reported to be a successful alternative to dialysis for some ESRD patients (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…The potential benefit of low protein diets for uremic patients has long been debated. Diet modification in uremia should relieve uremic symptoms, correct some of the complications seen in kidney failure, and preserve or improve the nutritional state of patients (4)(5)(6). Prebiotics on the other hand, as a non-digestible food beneficially affects the host by selectively stimulating the growth and /or activity of one or a limited number of bacteria (usually bifidobacteria and lactobacilli) in the colon and thus improves host health (7)(8)(9).…”

mentioning

confidence: 99%

Dialysis Free Protocol for Some End Stage Renal Disease Patients (Khosroshahi Protocol)

Khosroshahi

Kalantar‐Zadeh

2012

FFHD

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ABSTRACT:Background: The number of patients with End Stage Renal Disease (ESRD) is growing annually around the world. Provision of renal replacement therapy in the form of dialysis and transplant is relatively expensive. Recent studies have shown no survival benefit of early initiation of dialysis. Given recent outcome data of the timing of dialysis treatment and the expenses and logistics of hemodialysis procedure have stimulated research on alternative strategies. The aim of this study is to introduce another type of renal replacement therapy for selective patients with advanced chronic kidney disease (CKD). Methods:In a case series we used a so-called "dialysis free protocol" consisting of a low protein diet, uremic toxin adsorbents, and prebiotics for selective ESRD patients who had dialysis access constraints or did not agree placement of hemodialysis vascular access or peritoneal dialysis catheter.Findings: clinical and biochemical results of this study showed that these patients were not deteriorating during the study period and Blood Urea Nitrogen (Bun) & serum creatinin levels were not elevated in these months. Participating patients were relatively well throughout the study without signs of florid uremia and without a need for emergent or urgent dialysis. Conclusion:We conclude that our proposed dialysis free protocol reduces the need for dialysis treatment at least transiently. Whether this protocol can reduce the need for dialysis treatment requires additional studies.

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Selective effect of low protein diets in chronic renal diseases.

Cited by 111 publications

References 20 publications

Albuminuria, a Therapeutic Target for Cardiovascular Protection in Type 2 Diabetic Patients With Nephropathy

Albuminuria, a Therapeutic Target for Cardiovascular Protection in Type 2 Diabetic Patients With Nephropathy

Renoprotection

Dialysis Free Protocol for Some End Stage Renal Disease Patients (Khosroshahi Protocol)

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