Medical Nutritional Therapy for Patients with Chronic Kidney Disease not on Dialysis: The Low Protein Diet as a Medication

Journal of Clinical Medicine
Adamasco CupistiGiorgina Barbara Piccoli

Abstract

The 2020 Kidney Disease Outcome Quality Initiative (KDOQI) Clinical Practice Guideline for Nutrition in chronic kidney disease (CKD) recommends protein restriction to patients affected by CKD in stages 3 to 5 (not on dialysis), provided that they are metabolically stable, with the goal to delay kidney failure (graded as evidence level 1A) and improve quality of life (graded as evidence level 2C). Despite these strong statements, low protein diets (LPDs) are not prescribed by many nephrologists worldwide. In this review, we challenge the view of protein restriction as an "option" in the management of patients with CKD, and defend it as a core element of care. We argue that LPDs need to be tailored and patient-centered to ensure adherence, efficacy, and safety. Nephrologists, aligned with renal dietitians, may approach the implementation of LPDs similarly to a drug prescription, considering its indications, contra-indications, mechanism of action, dosages, unwanted side effects, and special warnings. Following this framework, we discuss herein the benefits and potential harms of LPDs as a cornerstone in CKD management.

References

Jan 1, 1991·American Journal of Nephrology·G BarsottiS Giovannetti
Nov 1, 1973·The Journal of Clinical Investigation·M WalserA W Coulter
Jul 1, 1981·The American Journal of Physiology·T H HostetterB M Brenner
Nov 1, 1995·Journal of the American Dietetic Association·T CoyneL Scherch
Jan 1, 1995·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·R T GansevoortP E de Jong
Apr 1, 1995·The American Journal of Physiology·K TomB J Maroni
Apr 23, 1999·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·B M WallC R Cooke
Feb 2, 2002·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Adamasco CupistiGiuliano Barsotti
Oct 21, 2003·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Philippe ChauveauMichel Aparicio
Dec 25, 2003·Journal of the American Society of Nephrology : JASN·William E Mitch, Guiseppe Remuzzi
Jul 3, 2004·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Adamasco CupistiGiuliano Barsotti
Mar 10, 2005·The American Journal of Clinical Nutrition·Kamyar Kalantar-ZadehTamara B Horwich
May 3, 2007·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Giuliano BrunoriGiovanni C Cancarini
May 18, 2007·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Denis FouqueRaymond Vanholder
Nov 6, 2007·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Bruno CianciarusoMassimo Sabbatini
Dec 25, 2007·Advances in Chronic Kidney Disease·Leslie Spry
Sep 10, 2008·The American Journal of Clinical Nutrition·Yu PanHui Min Jin
Dec 12, 2012·American Journal of Nephrology·Michael J FischerKevin T Stroupe
Feb 9, 2013·Clinical Journal of the American Society of Nephrology : CJASN·Nimrit GorayaDonald E Wesson
Feb 23, 2013·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Juan Jesús CarreroHarold A Franch
Feb 26, 2013·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Claudia D'AlessandroAdamasco Cupisti
Jun 12, 2013·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Giorgina B PiccoliFrancesco Porpiglia
Mar 1, 2014·Clinical Journal of the American Society of Nephrology : CJASN·Giorgina B PiccoliTullia Todros
May 13, 2014·Clinical Nutrition : Official Journal of the European Society of Parenteral and Enteral Nutrition·Nicolaas E P DeutzPhilip C Calder
Jul 2, 2014·Nature Reviews. Nephrology·Xiaonan H Wang, William E Mitch
Aug 12, 2014·Nutrition·Giorgina B PiccoliFrancesco Porpiglia
Aug 30, 2014·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Francesco S MenniniDenis Fouque
Nov 14, 2014·Clinical Journal of the American Society of Nephrology : CJASN·Juan Jesús Carrero
Feb 16, 2015·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Anuja P ShahJoel D Kopple
Mar 26, 2015·Current Opinion in Clinical Nutrition and Metabolic Care·Yoshitsugu ObiKamyar Kalantar-Zadeh
Jan 30, 2016·Journal of the American Society of Nephrology : JASN·Liliana GarneataGabriel Mircescu

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