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BMC Nephrol. 2016 Jul 19;17(1):90. doi: 10.1186/s12882-016-0304-9.

North American experience with Low protein diet for Non-dialysis-dependent chronic kidney disease.

Author information

1
Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA. kkz@uci.edu.
2
Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA. kkz@uci.edu.
3
Department Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA. kkz@uci.edu.
4
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA. kkz@uci.edu.
5
Houston Methodist Hospital, Houston, TX, USA.
6
Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.
7
Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA.
8
Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA.
9
Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
10
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
11
VA Connecticut Healthcare System, West Haven, CT, USA.
12
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
13
National Kidney Foundation, Inc., New York, NY, USA.
14
University of Tennessee Health Science Center, Memphis, TN, USA.

Abstract

Whereas in many parts of the world a low protein diet (LPD, 0.6-0.8 g/kg/day) is routinely prescribed for the management of patients with non-dialysis-dependent chronic kidney disease (CKD), this practice is infrequent in North America. The historical underpinnings related to LPD in the USA including the non-conclusive results of the Modification of Diet in Renal Disease Study may have played a role. Overall trends to initiate dialysis earlier in the course of CKD in the US allowed less time for LPD prescription. The usual dietary intake in the US includes high dietary protein content, which is in sharp contradistinction to that of a LPD. The fear of engendering or worsening protein-energy wasting may be an important handicap as suggested by a pilot survey of US nephrologists; nevertheless, there is also potential interest and enthusiasm in gaining further insight regarding LPD's utility in both research and in practice. Racial/ethnic disparities in the US and patients' adherence are additional challenges. Adherence should be monitored by well-trained dietitians by means of both dietary assessment techniques and 24-h urine collections to estimate dietary protein intake using urinary urea nitrogen (UUN). While keto-analogues are not currently available in the USA, there are other oral nutritional supplements for the provision of high-biologic-value proteins along with dietary energy intake of 30-35 Cal/kg/day available. Different treatment strategies related to dietary intake may help circumvent the protein- energy wasting apprehension and offer novel conservative approaches for CKD management in North America.

KEYWORDS:

CKD; Dietary protein intake; Dietary restriction; Low protein diet; Nutritional management

PMID:
27435088
PMCID:
PMC4952055
DOI:
10.1186/s12882-016-0304-9
[Indexed for MEDLINE]
Free PMC Article

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