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Open AccessCase Report

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

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Department of Clinical and Biological Sciences, University of Torino (TO), 10100 Torino, Italy
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Bioimis Accademia Alimentare, Bassano del Grappa (VI), 36061 Vicenza, Italy
3
Nephrology, Chivasso Hospital (Torino), 10034 Turin, Italy
4
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France
*
Author to whom correspondence should be addressed.
Nutrients 2017, 9(10), 1109; https://doi.org/10.3390/nu9101109
Received: 13 August 2017 / Revised: 22 September 2017 / Accepted: 6 October 2017 / Published: 11 October 2017
In advanced chronic kidney disease, obesity may bring a survival advantage, but many transplant centres demand weight loss before wait-listing for kidney graft. The case here described regards a 71-year-old man, with obesity-related glomerulopathy; referral data were: weight 110 kg, Body Mass Index (BMI) 37 kg/m2, serum creatinine (sCr) 5 mg/dL, estimated glomerular filtration rate (eGFR) 23 mL/min, blood urea nitrogen (BUN) 75 mg/dL, proteinuria 2.3 g/day. A moderately restricted, low-protein diet allowed reduction in BUN (45–55 mg/dL) and good metabolic and kidney function stability, with a weight increase of 6 kg. Therefore, he asked to be enrolled in a weight-loss program to be wait-listed (the two nearest transplant centres required a BMI below 30 or 35 kg/m2). Since previous low-calorie diets were not successful and he was against a surgical approach, we chose a qualitative, ad libitum coach-assisted diet, freely available in our unit. In the first phase, the diet is dissociated; he lost 16 kg in 2 months, without need for dialysis. In the second maintenance phase, in which foods are progressively combined, he lost 4 kg in 5 months, allowing wait-listing. Dialysis started one year later, and was followed by weight gain of about 5 kg. He resumed the maintenance diet, and his current body weight, 35 months after the start of the diet, is 94 kg, with a BMI of 31.7 kg/m2, without clinical or biochemical signs of malnutrition. This case suggests that our patients can benefit from the same options available to non-CKD (chronic kidney disease) individuals, provided that strict multidisciplinary surveillance is assured. View Full-Text
Keywords: chronic kidney disease; obesity; wait-listing for kidney transplantation; dialysis; weight loss; coach assisted diet; ad libitum diet chronic kidney disease; obesity; wait-listing for kidney transplantation; dialysis; weight loss; coach assisted diet; ad libitum diet
MDPI and ACS Style

Capizzi, I.; Teta, L.; Vigotti, F.N.; Tognarelli, G.; Consiglio, V.; Scognamiglio, S.; Piccoli, G.B. Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study. Nutrients 2017, 9, 1109.

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