Efficacy and Safety of a Very-Low-Protein Diet When Postponing Dialysis in the Elderly: A Prospective Randomized Multicenter Controlled Study

Brunori, Giuliano; Viola, Battista Fabio; Parrinello, Giovanni; Biase, Vincenzo De; Como, Giovanna; Franco, Vincenzo; Garibotto, Giacomo; Zubani, Roberto; Cancarini, Giovanni

doi:10.1053/j.ajkd.2007.02.278

Cited by 219 publications

(133 citation statements)

References 27 publications

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“…Based on the interventions and comparisons, the included studies were divided into the following groups: (i) those comparing LPD with higher‐protein diets10, 17, 18, 19, 20, 21, 22, 23, 24; (ii) those comparing VLPD with LPD10, 25, 26, 27, 28, 29, 30; and (iii) those involving other comparisons31, 32 ( Table 1). As all studies were not similar in their recruited patients and/or outcome measures, not all studies in each category were meta‐analysed ( Figures 2 and 3).…”

Section: Resultsmentioning

confidence: 99%

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Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

Rhee

Ahmadi

Kövesdy

et al. 2017

J cachexia sarcopenia muscle

173

126

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BackgroundRecent data pose the question whether conservative management of chronic kidney disease (CKD) by means of a low‐protein diet can be a safe and effective means to avoid or defer transition to dialysis therapy without causing protein‐energy wasting or cachexia. We aimed to systematically review and meta‐analyse the controlled clinical trials with adequate participants in each trial, providing rigorous contemporary evidence of the impact of a low‐protein diet in the management of uraemia and its complications in patients with CKD.MethodsWe searched MEDLINE (PubMed) and other sources for controlled trials on CKD to compare clinical management of CKD patients under various levels of dietary protein intake or to compare restricted protein intake with other interventions. Studies with similar patients, interventions, and outcomes were included in the meta‐analyses.ResultsWe identified 16 controlled trials of low‐protein diet in CKD that met the stringent qualification criteria including having 30 or more participants. Compared with diets with protein intake of >0.8 g/kg/day, diets with restricted protein intake (<0.8 g/kg/day) were associated with higher serum bicarbonate levels, lower phosphorus levels, lower azotemia, lower rates of progression to end‐stage renal disease, and a trend towards lower rates of all‐cause death. In addition, very‐low‐protein diets (protein intake <0.4 g/kg/day) were associated with greater preservation of kidney function and reduction in the rate of progression to end‐stage renal disease. Safety and adherence to a low‐protein diet was not inferior to a normal protein diet, and there was no difference in the rate of malnutrition or protein‐energy wasting.ConclusionsIn this pooled analysis of moderate‐size controlled trials, a low‐protein diet appears to enhance the conservative management of non‐dialysis‐dependent CKD and may be considered as a potential option for CKD patients who wish to avoid or defer dialysis initiation and to slow down the progression of CKD, while the risk of protein‐energy wasting and cachexia remains minimal.

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Section: Resultsmentioning

confidence: 99%

“…Two included studies31, 32 compared LPD/VLPD with other interventions: Brunori et al 31. completed a non‐inferiority trial of supplemented VLPD vs. dialysis in elderly ESRD patients without diabetes, and they observed that the survival was not higher in those who received VLPD.…”

Section: Resultsmentioning

confidence: 99%

Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

Rhee

Ahmadi

Kövesdy

et al. 2017

J cachexia sarcopenia muscle

173

126

View full text Add to dashboard Cite

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“…Some researchers argue that the low-protein diet is effective in protecting renal function and improving the prognosis. 29 Until 2008, the ADA guidelines had recommended protein restriction (0.8-1.0 g/kg for early nephropathy; 0.8 g/kg for late nephropathy). 7 However, in 2013, the ADA stated that protein restriction was not recommended for nephropathy.…”

Section: Low-protein Dietmentioning

confidence: 99%

“…It should also be recalled that the subjects of the randomized controlled trial investigating the effectiveness of the extremely low protein diet were also taking supplementations of nitrogen, essential amino acids, folic acids, or multivitamins. 29 These facts are important for understanding the risks associated with the low-protein diet.…”

Section: Low-protein Dietmentioning

confidence: 99%

Paradigm Shifts in Nutrition Therapy for Type 2 Diabetes

Yamada

2017

Keio J. Med.

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Currently, the low-energy diet is the only recognized nutrition therapy for type 2 diabetes in Japan. However, in recent decades, many foreign scientific organizations have accepted various nutritional approaches to manage diabetes, such as the low-carbohydrate diet, the Mediterranean diet, diet approaches to stop hypertension (DASH), and the vegetarian diet. Moreover, growing evidence has called into question classical nutritional approaches such as the low-fat diet for the prevention of cardiovascular disease and the low-protein diet for the prevention of diabetic kidney disease. Similarly, the recommended nutrition therapy for diabetes may change in near future. Such changes in nutrition therapy must be dynamic and based on not only scientific evidence but also each patient's narrative.

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“…Moderate protein restriction (0.6 to 0.8 g/kg per day) is associated with significant benefit of protein restriction in delaying renal dialysis [25,26,27] . It is generally well tolerated and does not lead to malnutrition in patients with CKD providing caloric goals are met, dietary protein is of high biologic value, and metabolic acidosis is avoided [28] .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis for the treatment of chronic kidney disease with low-protein diet

Mennini

Russo

Marcellusi

et al. 2013

FFHD

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ABSTRACT:Background: Several clinical studies have shown that a low protein diet in patients with Chronic Kidney Disease (CKD), delays and prevents the natural progression of the end stage renal disease (ESRD) and the necessary treatment of renal dialysis. Studies to investigate the effects of the low protein diets in preventing severe kidney failure are few for Italy. The aim of this study is to estimate the cost-effectiveness of a low protein diet treatment compared with no dietary treatment in patients with CKD 4-5 after 2, 3, 5 and 10 years.Methods: A Markov model simulating was developed to estimate costs and QALYs associated with low protein treatment and no treatment for patients with CKD 4-5. The prevalence of patients with CKD 4-5 refers to a population aged ≥40 years old was 0.3% estimated by a study of Gambaro et al. on the 2010. The transition probability was estimated on data from seven studies identified by a Cochrane review to determine the efficacy of low protein diets in delaying the need to start maintenance dialysis. The Quality Adjusted Life Years (QALYs) scores used were estimated with the Time Trade Off by a study of Gorodetskaya et al. in 2005. The costs of dialysis have been estimated by a study of Censis (2009) and amounted to approximately €34,071.7 per patient per year. The costs of a lowprotein diet refer to contributions of €1,440 per patient per year made by Lazio Region for patients that use a low-protein diet.Main Results / Conclusion: The treatment with a low-protein diet is more effective in terms of QALYs: the difference is always in favour of dietary treatment from a 0.09 after the first two years, 0.17 after three years, 0.37 after five years and up to a differential of 1 year after the first 10 years of treatment. In terms of cost-effectiveness, the dietary treatment is always

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Efficacy and Safety of a Very-Low-Protein Diet When Postponing Dialysis in the Elderly: A Prospective Randomized Multicenter Controlled Study

Cited by 219 publications

References 27 publications

Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

Paradigm Shifts in Nutrition Therapy for Type 2 Diabetes

Cost-effectiveness analysis for the treatment of chronic kidney disease with low-protein diet

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