European Medical Journal (Dec 2020)
Nutritional Management of Patients with Chronic Kidney Disease Through Low-Protein Diets
Abstract
Chronic kidney disease (CKD) is a global health problem, affecting approximately 10% of the adult population. It has a significant impact on patient quality of life and mortality rates, and increases costs for healthcare systems. Nutrition plays an important role in disease prevention, as it can help prevent hypertension and Type 2 diabetes mellitus, the two major underlying causes in CKD development. Medical nutrition therapy with protein reduction is an important pillar in the conservative management of patients with chronic renal failure and may improve overall patient outcomes. Its effects on uraemia, proteinuria, and metabolic acidosis have been demonstrated in numerous studies. Hence, the 2020 update to the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Nutrition in CKD has taken this into account, and recommends, with the highest level of evidence (1A), a diet with reduced protein intake in metabolically stable, nondialysis-dependent patients with CKD Stages 3–5. In practice, low-protein diets are often not particularly used for several reasons, such as concerns about the potentially increased risk for protein-energy wasting and poor adherence expectations. However, there is further evidence to show that a low-protein diet with adequate energy intake and high biological value protein supply, regularly followed by a trained dietitian, is safe and patient adherence increases with a personalised dietary approach, tailored to individual patient needs and considerations for dietary habits. Also, medical foods can help to facilitate reaching nutritional targets and preventing malnutrition, as they are a good source of almost nitrogen-free energy, providing only little amounts of protein, sodium, phosphorus, and potassium.
