Next Article in Journal
Serum Trace Elements and Their Associations with Breast Cancer Subgroups in Korean Breast Cancer Patients
Next Article in Special Issue
Vitamin K in Chronic Kidney Disease
Previous Article in Journal
Interplay between Nutrition and Hearing Loss: State of Art
Previous Article in Special Issue
Prevalence and Correlates of Sarcopenia among Elderly CKD Outpatients on Tertiary Care
Open AccessFeature PaperArticle

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
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
Show Figures

Figure 1

MDPI and ACS Style

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.

Show more citation formats Show less citations formats
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Search more from Scilit
 
Search
Back to TopTop