Low protein diet to postpone renal replacement therapy (RRT)

  1. Dr. Schär Institute
  2. Low protein diet to postpone renal replacement therapy (RRT)

Given the progressive worldwide increase of CKD, an effective conservative treatment for patients in the earlier stages is needed to help prevent the epidemic of end-stage renal disease (ESRD).

Further, many studies show that dialysis treatment may not prolong survival and has a significant negative impact on patient quality of life.

There is strong evidence that a medical nutritional therapy with reduced protein intake (<0.8 g/kg body weight) delays disease progression and postpones RRT by maintaining residual kidney function as much as possible. It can also help improve metabolic and fluid control, as well as prevent and correct signs, symptoms, and complications of advanced CKD.

Besides this classical low-protein diet, a very-low protein diet (0.3 g protein/kg body weight), supplemented with essential amino acids is a safe and effective treatment for motivated and well monitored patients to postpone the need for RRT as long as possible.

To prevent protein-energy wasting (PEW) monitoring by the nephrologist and a trained dietitian is fundamental to ensure the patient is receiving sufficient energy in their diet.

Reference

  1. Bellizzi V, Calella P, Carrero JJ and Fouque D. Supplemented very low protein diet to postpone renal failure: Pathophysiology and clinical applications in chronic kidney disease. Chronic disease and translational medicine, 2018; 4.
  2. Brunori G et al. Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am J Kidney Dis., 2007; 49(5):569-80.
  3. Davidson SN, Levi A, Moss AH et al. Executive summary of the KDIGO controversies conference on supportive care in chronic kidney disease: developing a roadmap to improving quality care. Kidney Int, 2015; 88:447-449.
  4. Kalantar-Zadeh K et al. Nutritional Management of Chronic Kidney Disease. N Engl J Med, 2017; 377:1765-76.
  5. Piccoli GB and Cupisti A. Let food be the medicine: lessons from low-protein diets from around the world. BMC Nephrology, 2017; 18:102.