Abstract
BackgroundThe impact of the low-protein diet on nutrition in CKD diabetics is uncertain.MethodsThe metabolic and nutritional effects of a low-protein (0.5–0.6 g/kg/d), normal-high energy (30–35 kcal/kg/d) diet supplemented with ketoacids (LPD-KA) were prospectively evaluated in CKD patients with (DM) and without (non-DM) diabetes mellitus.Results197 patients on CKD stages 3–5 were enrolled. DM (n = 81) and non-DM (n = 116) were comparable for gender (Male 58 vs 55%), age (66 ± 9 vs 63 ± 18 years), renal function (eGFR 23 ± 13 vs 24 ± 13 mL/min). After 6-month, serum urea (DM: 131 ± 58 to 105 ± 49 mg/dl, p < 0.05; non-DM: 115 ± 52 to 88 ± 36, p < 0.05) and phosphate (DM: 4.5 ± 1.3 to 4.1 ± 1.2 mg/dl, p = 0.06; non-DM: 4.3 ± 1.0 to 3.7 ± 0.8, p < 0.05) declined. Fasting glucose decreased in DM (126 ± 52 to 103 ± 29 mg/dl, p < 0.05) without insulin dose increase. These effects were preserved after 3-year. Serum albumin did not change after 6 months (DM: 3.7 ± 0.6 to 3.8 ± 0.4 mg/dl; non-DM: 4.0 ± 0.6 to 4.0 ± 0.4) and in the long-term. Body weight (BW) declined after the diet start (DM: 68.9 ± 14.3 to 65.1 ± 12.1 kg, p < 0.05; non-DM: 66.6 ± 15.1 to 64.1 ± 15.1, p < 0.05) and was stable at 6 months and 3 years. Muscle strength at baseline was reduced in all patients and remained stable during the diet period. Changes of nutritional markers during the study were similar among groups and diabetes was not associated to any nutritional change at the multivariate analysis. As attain wasting, lower BMI (< 23 kg/m2) and albumin (< 3.8 g/dl) levels were present in 1/3 patients at start and along 3 years, cholesterol never dropped below the lower threshold (< 100 mg/dl) and poorer FM (< 10%) was less than 10% during the study in both groups.ConclusionsIn diabetic CKD patients a low-protein diet supplemented with ketoacids improves uremia and diabetes, causes sudden decline of body weight which remains stable over time and has not a negative effect on wasting and muscle mass and fitness. In diabetic CKD patients the LPD-KA is safe and the nutritional impact is the same as in non-diabetics CKD.
Highlights
The impact of the low-protein diet on nutrition in chronic kidney disease (CKD) diabetics is uncertain
If the inclusion criteria were confirmed, patients underwent a dietitian evaluation and were prescribed a low-protein diet supplemented with ketoacids (LPD-KA), containing 0.5–0.6 g proteins/kg ideal Body Weight (iBW)/day, low amount of purines, sodium (< 2 g/day) and phosphorus (< 800 mg/day) and normal-high amount of energy (30–35 kcal/kg iBW/day)
Patients Among the screened patients, those who refused the nutritional treatment or declared they cannot be adherent to the Low-Protein Diet (LPD) or did not meet the inclusion criteria were excluded; these patients were not submitted to any further evaluation
Summary
During the last decades the prevalence of chronic kidney disease (CKD) increased worldwide, the end-stage renal disease (ESRD) has become one of the major causes of mortality in the world and the use of renal replacement therapy is projected to double by 2030 [1, 2]. It emerged that dialysis is not capable to prolong life while, in contrast, reduces the quality of the life and the individual functional capacity in most patients [3]. A regular clinical follow-up and a strict dietitian assistance, allows to maintain of a good nutritional status with such LPD-KA, even in elderly patients [13]
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