Abstract
Prescribing a low-protein diet (LPD) is part of the standard management of patients in advanced stages of chronic kidney disease (CKD). However, studies on the quality of life (QoL) of patients on LPDs are lacking, and the impact these diets have on their QoL is often given as a reason for not prescribing one. We, therefore, decided to assess the QoL in a cohort of CKD stage 3–5 patients followed up by a multiple-choice diet approach in an outpatient nephrology clinic in France. To do so, we used the short version of the World Health Organization’s quality of life questionnaire and compared the results with a historical cohort of Italian patients. We enrolled 153 patients, managed with tailored protein restriction in Le Mans, and compared them with 128 patients on similar diets who had been followed in Turin (Italy). We found there were no significant differences in terms of age (median 73 vs. 74 years, respectively), gender, CKD stage, and comorbidities (Charlson’s Comorbidity Index 7 vs. 6). French patients displayed a greater body mass index (29.0 vs. 25.4, p < 0.001) and prevalence of obesity (41.2 vs. 15.0%, p < 0.001). Baseline protein intake was over the target in France (1.2 g/kg of real body weight/day). In both cohorts, the burden of comorbidities was associated with poorer physical health perception while kidney function was inversely correlated to satisfaction with social life, independently of the type of diet. Our study suggests that the type of LPD they follow does not influence QoL in CKD patients and that a personalized approach towards protein restriction is feasible, even in elderly patients.
Highlights
Following several large trials and observational studies it has been realized that the risk of impairing nutritional status is much lower than was once thought and it is held that, when correctly prescribed and followed, these diets do not lead to protein-energy wasting, and may even result in an improvement in nutritional status, in spite of protein reduction [4,5,6,7,8]
There are several reasons for this: focusing attention on energy intake may lead to the optimization of protein metabolism; a lower protein intake, in particular of proteins of animal origin, often leads to better control of acidosis and improves the calcium–phosphate balance; and attention to quality of food can limit exposure to toxic additives, including, but not limited to, inorganic phosphate [4,5,6,7]
While there are many studies analyzing the effect of these diets on chronic kidney disease progression and metabolic interferences, as well as on mortality, there are comparatively few studies addressed to low-protein diet (LPD)’ potential effect on Quality of Life (QoL)
Summary
Following several large trials and observational studies it has been realized that the risk of impairing nutritional status is much lower than was once thought and it is held that, when correctly prescribed and followed, these diets do not lead to protein-energy wasting, and may even result in an improvement in nutritional status, in spite of protein reduction [4,5,6,7,8]. There are several reasons for this: focusing attention on energy intake may lead to the optimization of protein metabolism; a lower protein intake, in particular of proteins of animal origin, often leads to better control of acidosis and improves the calcium–phosphate balance; and attention to quality of food can limit exposure to toxic additives, including, but not limited to, inorganic phosphate [4,5,6,7]
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