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

1
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France
2
SCDU Urology, Department of Oncology, ASOU San Luigi, University of Torino, 10043 Orbassano, Italy
3
Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, 10043 Orbassano, Italy
4
Obstetrics, Department of Surgery, Città della Salute e della Scienza, University of Torino, Torino 10126, Italy
5
SS Epidemiology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, 10043 Orbassano, Italy
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(1), 36; https://doi.org/10.3390/nu11010036
Received: 24 November 2018 / Revised: 8 December 2018 / Accepted: 17 December 2018 / Published: 24 December 2018
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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. View Full-Text
Keywords: chronic kidney disease; protein restriction; protein intake; obesity; diabetes; compliance chronic kidney disease; protein restriction; protein intake; obesity; diabetes; compliance
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Fois, A.; Chatrenet, A.; Cataldo, E.; Lippi, F.; Kaniassi, A.; Vigreux, J.; Froger, L.; Mongilardi, E.; Capizzi, I.; Biolcati, M.; Versino, E.; Piccoli, G.B. Moderate Protein Restriction in Advanced CKD: A Feasible Option in An Elderly, High-Comorbidity Population. A Stepwise Multiple-Choice System Approach. Nutrients 2019, 11, 36.

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