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Article

Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet

1
Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
2
Nutritional Science and Dietetic, Maggiore della Carità University Hospital, 28100 Novara, Italy
3
Clinical Chemistry Unit, Fondazione IRCCS Ca’ Granda Maggiore Policlinico Hospital, 20122 Milano, Italy
4
Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy
5
Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, 28100 Novara, Italy
6
Néphrologie et Dialyse, Centre Hospitalier Le Mans, 72037 Le Mans, France
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Vincent Lee
Nutrients 2022, 14(3), 487; https://doi.org/10.3390/nu14030487
Received: 29 December 2021 / Revised: 17 January 2022 / Accepted: 21 January 2022 / Published: 23 January 2022
(This article belongs to the Special Issue Nutritional Approach for Patients with Advanced CKD)
Background. In medicine, “compliance” indicates that the patient complies with the prescriber’s recommendations, “adherence” means that “the patient matches the recommendations” and “concordance” means “therapeutic alliance” between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. Patients. Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A2 (Lp-PLA2) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. Results. nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA2, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. Conclusion. This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in “adherent” and “concordant” patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions. View Full-Text
Keywords: low protein diet; chronic kidney disease; compliance; adherence; concordance; p-cresol; indoxyl-sulphate; lipoprotein-associated phospholipase A2 low protein diet; chronic kidney disease; compliance; adherence; concordance; p-cresol; indoxyl-sulphate; lipoprotein-associated phospholipase A2
MDPI and ACS Style

De Mauri, A.; Carrera, D.; Vidali, M.; Bagnati, M.; Rolla, R.; Riso, S.; Torreggiani, M.; Chiarinotti, D. Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet. Nutrients 2022, 14, 487. https://doi.org/10.3390/nu14030487

AMA Style

De Mauri A, Carrera D, Vidali M, Bagnati M, Rolla R, Riso S, Torreggiani M, Chiarinotti D. Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet. Nutrients. 2022; 14(3):487. https://doi.org/10.3390/nu14030487

Chicago/Turabian Style

De Mauri, Andreana, Deborah Carrera, Matteo Vidali, Marco Bagnati, Roberta Rolla, Sergio Riso, Massimo Torreggiani, and Doriana Chiarinotti. 2022. "Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet" Nutrients 14, no. 3: 487. https://doi.org/10.3390/nu14030487

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