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    Nutritional Intervention in Chronic Kidney Disease: Editorial

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    Daniel Darmawan
    The document discusses the history and current use of low-protein diets and supplemented very low-protein diets for patients with chronic kidney disease. While such diets were once commonly prescribed, they have fallen out of favor in recent decades though studies have not found them to cause malnutrition when properly monitored. The document argues that nutritional interventions including supplemented very low-protein diets can help slow kidney disease progression and control metabolic issues, but patients require careful nutritional monitoring by dietitians and nephrologists.

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    Nutritional Intervention in Chronic Kidney Disease: Editorial

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    Daniel Darmawan
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    The document discusses the history and current use of low-protein diets and supplemented very low-protein diets for patients with chronic kidney disease. While such diets were once commonly prescribed, they have fallen out of favor in recent decades though studies have not found them to cause malnutrition when properly monitored. The document argues that nutritional interventions including supplemented very low-protein diets can help slow kidney disease progression and control metabolic issues, but patients require careful nutritional monitoring by dietitians and nephrologists.

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    The document discusses the history and current use of low-protein diets and supplemented very low-protein diets for patients with chronic kidney disease. While such diets were once commonly prescribed, they have fallen out of favor in recent decades though studies have not found them to cause malnutrition when properly monitored. The document argues that nutritional interventions including supplemented very low-protein diets can help slow kidney disease progression and control metabolic issues, but patients require careful nutritional monitoring by dietitians and nephrologists.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    47 views2 pages

    Nutritional Intervention in Chronic Kidney Disease: Editorial

    Uploaded by

    Daniel Darmawan
    The document discusses the history and current use of low-protein diets and supplemented very low-protein diets for patients with chronic kidney disease. While such diets were once commonly prescribed, they have fallen out of favor in recent decades though studies have not found them to cause malnutrition when properly monitored. The document argues that nutritional interventions including supplemented very low-protein diets can help slow kidney disease progression and control metabolic issues, but patients require careful nutritional monitoring by dietitians and nephrologists.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    EDITORIAL

    Nutritional Intervention in Chronic


    Kidney Disease

    IETARY PROTEIN RESTRICTION has


    been prescribed in chronic kidney disease
    (CKD) for a century, and a low-protein diet
    (LPD) or supplemented very low-protein diet
    with ketoanalogs of amino acids (SVLPD) has
    been prescribed for four decades. It was argued
    that such a regimen may be associated with a deterioration of nutritional status. Such intervention is uncommon now in the United States
    and in most European countries, in which a standard diet with 0.8 g/kg/day of protein is commonly used. At the same time, most patients
    present signs of protein-energy malnutrition at
    the start of renal replacement therapy (RRT),
    even if they have consulted a nephrologist in
    the preceding months or years. The Comprehensive Dialysis Study, which is part the United States
    Renal Data System (USRDS) 2008 data report,
    involved a special collection of data on the nutrition, activity, and quality of life of patients who
    initiated RRT between 2005 and 2007. The first
    results showed that at the start of RRT, 60%
    of patients exhibited a serum albumin level lower than 35 g/L, and in 80% of these patients,
    the alimentary intake was below the actual
    recommendations.1
    In contrast, during the last several decades,
    no study demonstrated that LPD or SVLPD
    was associated with malnutrition. The first and
    second analyses of the Modification of Diet in
    Renal Diseases (MDRD)-Study concluded that
    such a regimen is safe in uncomplicated and
    carefully monitored cases. Short-term follow-up

    P. C. received a consultancy fee.


    This article was published as part of a supplement sponsored by an
    unrestricted educational grant from Fresenius Kabi.
    2009 by the National Kidney Foundation, Inc. All rights
    reserved.
    1051-2276/09/1905S-0001$36.00/0
    doi:10.1053/j.jrn.2009.06.018

    Journal of Renal Nutrition, Vol 19, No 5S (September), 2009: pp S1S2

    of SVLPD patients showed no adverse nutritional effects after patients started dialysis, or
    during and after transplantation. One could object that these patients were carefully selected
    and monitored. This last point is important, because a nutritional survey should be the main
    feature of an adequate, long-term follow-up
    of CKD patients before RRT. The implementation of nutritional guidelines is associated
    with better results.2 A review of the literature
    regarding protein intake and CKD confirmed
    that nutritional therapy is effective to reduce
    comorbidities associated with CKD: nutrition,
    phosphate intake, proteinuria, and cardiovascular risk factors.
    All the reports from this symposium demonstrate that nutritional intervention in CKD patients is not an outmoded therapy based on
    antiquated clinical studies, and that a supplemented, protein-restricted diet has its place in
    a therapeutic approach. The long-term followup of patients in previous studies confirmed
    the safety and nutritional adequacy of these diets, and recent clinical studies of nondiabetic
    and diabetic patients led to the same conclusions. The experimental and clinical studies reported in this issue of the Journal illustrate all
    the mechanisms (and new directions) involved
    in the beneficial effects of LPDs supplemented
    with keto acids/amino acids: the effects on proteinuria and endothelial dysfunction, specific
    effects of branched-chain amino acids, effects
    of keto acids/amino acids on asymmetric dimethylarginine and body fat mass, and effects on
    glomerular structure and renal fibrosis. Clinical
    studies confirm previous studies and metaanalyses: SVLPDs delay the time to RRT, and
    could be of economic importance. Clinical
    studies also confirm the positive effects suggested by experimental data in terms of obese
    transplanted patients, diabetic patients, and the
    preservation of renal function in peritoneal
    dialysis patients. To help nephrologists and
    S1

    S2

    EDITORIAL

    dietitians, the expert panel proposes a consensus


    statement on keto acid therapy in diabetic or
    nondiabetic predialysis patients and in nephrotic
    syndrome.
    In conclusion, nutritional interventions and
    specifically supplemented very low protein diets
    have many proven advantages in terms of the
    progression of renal failure, better metabolic and
    endocrine control, and decreased proteinuria.
    Patients are in need of a detailed nutritional
    survey by dietitians and nephrologists. This should
    be the case for all CKD patients, but especially for
    SVLPD patients, to avoid malnutrition. Toward
    this goal, all the data reported in this issue by
    international experts on this topic will help.

    and will offer some new directions for future


    research.
    Philippe Chauveau, MD
    Nephrology Department, Hopital Pellegrin and
    Aurad-Aquitaine, Bordeaux, France

    References
    1. Kutner NG, Johansen KL, Kaysen GA, et al: The Comprehensive Dialysis Study (CDS): a USRDS special study. Clin J Am
    Soc Nephrol 4:645650, 2009.
    2. Campbell KL, Ash S, Zabel R, McFarlane C, Juffs P,
    Bauer JD: Implementation of standardized nutrition guidelines
    by renal dietitians is associated with improved nutrition status.
    J Ren Nutr 19:136144, 2009.

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