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Open AccessArticle

Low-Protein Diets in Diabetic Chronic Kidney Disease (CKD) Patients: Are They Feasible and Worth the Effort?

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Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy
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Nephrologie, Centre Hospitalier Le Mans, Le Mans 72100, France
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SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy
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SCDU Endocrinologia, Diabetologia e Metabolismo, Città della Salute e della Scienza Torino, Torino 10100, Italy
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SC Nefrologia, Brotzu Hospital, Cagliari 09134, Italy
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SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy
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SSD Epidemiology, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy
*
Authors to whom correspondence should be addressed.
Nutrients 2016, 8(10), 649; https://doi.org/10.3390/nu8100649
Received: 7 August 2016 / Revised: 11 September 2016 / Accepted: 3 October 2016 / Published: 21 October 2016
(This article belongs to the Special Issue Nutrition and Chronic Kidney Disease)
Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan–Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%, p = 0.002) as well as comorbidity (median Charlson index 8 vs. 6 p = 0.002). Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups): about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate) < 15 mL/min, and 1 year after reaching e-GFR < 10 mL/min. In patients with type 2 diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity. View Full-Text
Keywords: chronic kidney disease; low-protein diets; diabetes; diabetic nephropathy; patient survival; dialysis start chronic kidney disease; low-protein diets; diabetes; diabetic nephropathy; patient survival; dialysis start
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Piccoli, G.B.; Ventrella, F.; Capizzi, I.; Vigotti, F.N.; Mongilardi, E.; Grassi, G.; Loi, V.; Cabiddu, G.; Avagnina, P.; Versino, E. Low-Protein Diets in Diabetic Chronic Kidney Disease (CKD) Patients: Are They Feasible and Worth the Effort? Nutrients 2016, 8, 649.

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