6-tips diet: a simplified dietary approach in patients with chronic renal disease. A clinical randomized trial

Abstract

Background The beneficial effects of dietary restriction of proteins in chronic kidney disease are widely recognized; however, poor compliance to prescribed low-protein diets (LPD) may limit their effectiveness. To help patients to adhere to the dietary prescriptions, interventions as education programmes and dietary counselling are critical, but it is also important to develop simple and attractive approaches to the LPD, especially when dietitians are not available. Therefore, we elaborated a simplified and easy to manage dietary approach consisting of 6 tips (6-tip diet, 6-TD) which could replace the standard, non-individualized LPD in Nephrology Units where dietary counselling is not available; hence, our working hypothesis was to evaluate the effects of such diet vs a standard moderately protein-restricted diet on metabolic parameters and patients' adherence. Methods In this randomized trial, 57 CKD patients stage 3b-5 were randomly assigned (1:1) to receive the 6-TD (Group 6-TD) or a LPD containing 0.8 g/kg/day of proteins (Group LPD) for 6 months. The primary endpoint was to evaluate the effects of the two different diets on the main ''metabolic'' parameters and on patients' adherence (registration number NCT01865526). Results Both dietary regimens were associated with a progressive reduction in protein intake and urinary urea excretion compared to baseline, although the decrease was more pronounced in Group 6-TD. Effects on serum levels of urea nitrogen and urinary phosphate excretion were greater in Group 6-TD. Plasma levels of phosphate, bicarbonate and PTH, and urinary NaCl excretion remained stable in both groups throughout the study. 44 % of LPD patients were adherent to the dietary prescription vs 70 % of Group 6-TD. Conclusions A simplified diet, consisting of 6 clear points easily managed by CKD patients, produced beneficial effects either on the metabolic profile of renal disease and on patients' adherence to the dietary plan, when compared to a standard LPD.

Dietary protein intake and chronic kidney disease

“…[63] Education with simplified diet approach could also assist in robust adherence. [64–66] In a RCT with CKD stage 3 patients, renal nutrition education program including individual class, hands-on sessions about food types, and recipe distribution improved adherence to LPD. [67] Better knowledge about patient’s preference for food types and continuous effort to find new solutions for better tolerability would be essential for successful dietary treatment.…”

The Lived Experiences of Living with LPD among CKD Patients in Southern Taiwan

“…In addition, the provision of a simplified dietary approach and simple tips from one integrated case manager or dietician could reduce the confusion involved with adopting a LPD. Pisani [10] conducted a randomized trial in Italy using a new strategy consisting of six clear points that could easily be managed by patients with CKD. This strategy improved the metabolic profile of renal disease and patients' adherence.…”

“…studies have shown that a low-protein diet (LPD) plays an important role in reducing the progression of CKD [8][9][10][11], as it can maintain the nitrogen balance and assist with tissue repair in the body [11,12]. In general, the minimum daily protein requirement for adults is 0.8-1.0 g/kg/day.…”

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

“…A key finding to reach ample adherence to the low-protein diet is to individualize the dietary strategies and at the same time to build up specific intensive counseling/education programs for patients (68). The message for our patients is that we do not need the patient to follow the diet we prescribed perfectly but to work with us to find the best solution for realizing a new style, which should be considered as a therapy to all effects (45,47).…”

“…Finally, it is important to provide practical advice: no more structured dietary plans, nutritionally sound but complex to realize, or long lists of foods to exclude (potassium, phosphorus, sodium, protein lists), but useful and simplified basic information on how to change habits and help patients combine ingredients to create enjoyable meals that fit recommendations for CKD (47)(48)(49). What treatment for calcium/PTH will affect CKD progression?…”