Abstract
Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan–Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%, p = 0.002) as well as comorbidity (median Charlson index 8 vs. 6 p = 0.002). Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups): about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate) < 15 mL/min, and 1 year after reaching e-GFR < 10 mL/min. In patients with type 2 diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity.
Highlights
Diabetic nephropathy is a complex condition with varying clinical manifestations and responses to therapy
chronic kidney disease (CKD) was defined according to the Kidney Disease Outcome Quality Initiative (K/DOQI)
Survival is significantly affected by Charlson index, but neither the presence of diabetes, nor Survival is significantly affected by Charlson index, but neither the presence diabetes, kidney function or proteinuria at baseline retain a significant effect on mortality in Coxofanalysis
Summary
Diabetic nephropathy is a complex condition with varying clinical manifestations and responses to therapy. Nutrients 2016, 8, 649 filtration rate (GFR), micro-albuminuria, proteinuria and hypertension, to reduced GFR with increasing proteinuria [1] This pattern, clearly identified in type 1 diabetic patients, does not precisely describe the situation of a growing cohort of type 2 diabetic patients, mainly characterized by scarce proteinuria and diffuse vascular disease. Several studies have tried to highlight the differences between diabetes as a primary cause of CKD and diabetes as a comorbid condition, leading to conflicting data. This is on account of the definition of diabetic nephropathy, based upon proteinuria, diabetes duration, retinopathy or, more rarely, kidney biopsy [10,11,12,13]. We compared the results obtained in 149 diabetic patients with a homogeneously treated cohort of 300 non-diabetic patients, followed-up in the same setting, in the period 2007–2015
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