Medical nutrition therapy in diabetic nephropathy

  1. Medical nutrition therapy in diabetic nephropathy

De Waal et al (2016) conducted a retrospective cohort analysis of data from 265 CKD (stages 3-5) patients at the University of Vermont Medical Center.

Among the 265 CKD patients, 147 received medical nutrition therapy (MNT) from a renal Registered Dietitian (RD), and 118 did not. The MNT group experienced a significant reduction in GFR decline, compared to the control group (0.3ml/min/1.73m2 vs. 9.9ml/min/1.73m2), 2-sample test P<0.001). Time to the start of dialysis, using survival analysis and Cox proportional hazards regression, indicated that the control group were 3.15 times more likely to initiate dialysis than the MNT group. Additionally, biomarkers for CKD (calcium, phosphorus, iPTH, albumin, and BUN) were found to be in the normal range at a higher percentage within the MNT group than the controls.

In a randomized clinical trial involving 60 type 2 diabetic patients over a 3 month period, Velazques Lopez et al (2008), found those on LPD (n=29, 0.6-0.8g/kg/day) and experiencing macroalbuminuria improved renal function as observed by a decrease in urinary albumin excretion rate (UAER, 1280.7 ± 1139.7 to 444.4 ± 329.8 mg/day; p <0.05) and an increase in GFR (56.3 ± 29.0-74.2 ± 40.4 ml/min; p < 0.05).

Hansen et al. (2002) conducted a 4 year prospective, randomized, unmasked, controlled trial at the Steno Diabetes Center. This study involved 82 type 1 diabetics between the ages of 18 to 60 years. For protein consumption, an iso-caloric LPD of 0.6g/kg/day was prescribed to patients in the LPD group (n=41) and the control group (n=41) received a usual-protein diet (1.0-1.2g/kg/day). While fewer patients on the LPD reached ESRD or death compared to those on the usual protein diet (LPD: 4 patients vs Control: 11 patients, P=0.042, figure 1), the rate of GFR decline slowed significantly in both diet groups during the four years of follow-up (3.9 mL/min/year in the usual-protein diet group vs. 3.8 in the low-protein diet group), while urinary albumin excretion rate remained unchanged among type 1 diabetics. 

dsi-type-1-diabetic-patients-graph
Figure 1. Type 1 diabetic patients with progressive diabetic nephropathy in control group (solid) and LPD group (clear) that reach ESRD or death within 4 years of study initiation (Adopted from Hansen et al.).

 

Reference

  1. De Waal, D., Heaslip, E., Callas, P. Medical Nutrition Therapy for Chronic Kidney Disease Improves     Biomarkers and Slows Time to Dialysis. Journal of Renal Nutrition, 2016; 26(1):1-9.
  2. Velazquez Lopez, L., Sil Acosta, M.J., Goycochea Robles, M.V., et al. Effect of protein restriction diet on renal function and metabolic control in patients with type 2 diabetes: a randomized clinical trial.  Nutricion    Hospitalaria, 2008; 23(2): 141-147.
  3. Hansen, H.P., Tauer-Lassen, E., Jensen, B.R., et al. Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney International, 2002; 62:220-228.