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Nutrients. 2018 Dec 24;11(1). pii: E36. doi: 10.3390/nu11010036.

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

Author information

1
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. antiocofois@gmail.com.
2
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. antoine.chatrenet@gmail.com.
3
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. emanuela.cataldo@gmail.com.
4
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. flippi@ch-lemans.fr.
5
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. akkaniassi@ch-lemans.fr.
6
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. jevigreux@ch-lemans.fr.
7
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. lfroger@ch-lemans.fr.
8
SCDU Urology, Department of Oncology, ASOU San Luigi, University of Torino, 10043 Orbassano, Italy. elenamongilardi@yahoo.it.
9
Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, 10043 Orbassano, Italy. irene.ccapizzi@gmail.com.
10
Obstetrics, Department of Surgery, Città della Salute e della Scienza, University of Torino, Torino 10126, Italy. marilisa.biolcati@unito.it.
11
SS Epidemiology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, 10043 Orbassano, Italy. elisabetta.versino@unito.it.
12
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. gbpiccoli@yahoo.it.
13
Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, 10043 Orbassano, Italy. gbpiccoli@yahoo.it.

Abstract

BACKGROUND:

Protein restriction may retard the need for renal replacement therapy; compliance is considered a barrier, especially in elderly patients.

METHODS:

A feasibility study was conducted in a newly organized unit for advanced kidney disease; three diet options were offered: normalization of protein intake (0.8 g/kg/day of protein); moderate protein restriction (0.6 g/kg/day of protein) with a "traditional" mixed protein diet or with a "plant-based" diet supplemented with ketoacids. Patients with protein energy wasting (PEW), short life expectancy or who refused were excluded. Compliance was estimated by Maroni-Mitch formula and food diary.

RESULTS:

In November 2017⁻July 2018, 131 patients started the program: median age 74 years (min⁻max 24-101), Charlson Index (CCI): 8 (min-max: 2⁻14); eGFR 24 mL/min (4⁻68); 50.4% were diabetic, BMI was ≥ 30 kg/m² in 40.4%. Normalization was the first step in 75 patients (57%, age 78 (24⁻101), CCI 8 (2⁻12), eGFR 24 mL/min (8⁻68)); moderately protein-restricted traditional diets were chosen by 24 (18%, age 74 (44⁻91), CCI 8 (4⁻14), eGFR 22 mL/min (5⁻40)), plant-based diets by 22 (17%, age 70 (34⁻89), CCI 6.5 (2⁻12), eGFR 15 mL/min (5⁻46)) (p < 0.001). Protein restriction was not undertaken in 10 patients with short life expectancy. In patients with ≥ 3 months of follow-up, median reduction of protein intake was from 1.2 to 0.8 g/kg/day (p < 0.001); nutritional parameters remained stable; albumin increased from 3.5 to 3.6 g/dL (p = 0.037); good compliance was found in 74%, regardless of diets. Over 1067 patient-months of follow-up, 9 patients died (CCI 10 (6⁻12)), 7 started dialysis (5 incremental).

CONCLUSION:

Protein restriction is feasible by an individualized, stepwise approach in an overall elderly, high-comorbidity population with a baseline high-protein diet and is compatible with stable nutritional status.

KEYWORDS:

chronic kidney disease; compliance; diabetes; obesity; protein intake; protein restriction

PMID:
30586894
PMCID:
PMC6356994
DOI:
10.3390/nu11010036
[Indexed for MEDLINE]
Free PMC Article

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