Abstract
Dietary therapy represents an important tool in the management of chronic kidney disease (CKD), mainly through a balanced reduction of protein intake aimed at giving the remnant nephrons in damaged kidneys a “functional rest”. While dialysis, transplantation, and pharmacological therapies are usually seen as “high tech” medicine, non pharmacological interventions, including diets, are frequently considered lifestyle-complementary treatments. Diet is one of the oldest CKD treatments, and it is usually considered a part of “mainstream” management. In this narrative review we discuss how the lessons of complementary alternative medicines (CAMs) can be useful for the implementation and study of low-protein diets in CKD. While high tech medicine is mainly prescriptive, prescribing a “good” life-style change is usually not enough and comprehensive counselling is required; the empathic educational approach, on which CAMs are mainly, though not exclusively based, may support a successful personalized nutritional intervention.There is no gold-standard, low-protein diet for all CKD patients: from among a relatively vast choice, the best compliance is probably obtained by personalization. This approach interferes with the traditional RCT-based analyses which are grounded upon an assumption of equal preference of treatments (ideally blinded). Whole system approaches and narrative medicine, that are widely used in the study of CAMs, may offer ways to integrate EBM and personalised medicine in the search for innovative solutions respecting individualization, but gaining sound data, such as with partially-randomised patient preference trials.
Highlights
Chronic kidney disease (CKD): an example of a highly complex, life-long disease Dialysis and transplantation are life-long, life-sustaining treatments requiring multiple drug therapies, and a high technological level of “mainstream medicine” [1–3]
chronic kidney disease (CKD) treatments merge technology, which belongs to/“mainstream medicine”, and lifestyle interventions which are often considered a part of the holistic approach attributed to “complementary and alternative medicine” (CAM)
While several comprehensive reviews have addressed the issue of the efficacy of various therapeutic approaches, including diet, to date, no reviews have been dedicated to the relationship between a mainstream and a CAM approach to low protein diets in CKD patients
Summary
Chronic kidney disease (CKD): an example of a highly complex, life-long disease Dialysis and transplantation are life-long, life-sustaining treatments requiring multiple drug therapies, and a high technological level of “mainstream medicine” [1–3]. The first reason why the treatment with the best costbenefit ratio is underutilized in the expensive CKD scenario may be the difference between the amount of time it takes to prescribe a drug or define the parameters of a dialysis treatment (mainly requiring technical skills), and to recommend lifestyle changes (especially in the case of diet) which are deeply rooted in personal preferences and social habits In this regard, the barriers for the implementation of LPDs may be the result of the difficulty in conciliating the prescription and follow-up of a diet with a classic “mainstream medicine” approach. The protein content in vegan diets is lower than in omnivorous diets, and
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