The Power of Hypoproteic Nutrition in End-stage Renal Failure is Like Real Therapy

Abstract

The purpose of this editorial is to highlight some properties of the hypoproteic nutrition in chronic renal disease (CKD), which can be defined as real therapy and are often misunderstood. These include: preventing the worsening and rapid progression of residual renal function (RRF), delaying replacement treatment, reducing the production of much more toxic nitrogenous compound molecules, such as protein-bound uremic toxins, and obtaining a phosphorus balance that could lead to a better control of uremic osteopathy and a lower incidence of cardiovascular events, thus improving survival rates in end-stage renal disease (ESRD) patients. In turn, we acknowledge a new approach called “incremental dialysis”, which, thanks to a lower protein intake, can be employed with many patients with limited RRF and a good dietetic compliance. In our opinion, this approach must be mandatory applied for reducing dialysis frequency, such as once-weekly haemodialysis (HD), via an intervention we define as a combined diet dialysis programme (CDDP). The term incremental HD (IH) is used and often confused with “infrequent dialysis” by many authors who use the same term interchangeably for once- and twice-weekly-dialysis without proteic diet control and too limited RRF. However, the milestone concepts are as follows: adopting a dietary hypoproteic approach is needed for medium-advanced stages of CKD by avoiding useless and harmful dialysis “overdose”. Finally, in CKD nowadays, it is necessary to administer amino acids, while we must seriously consider the treatment of uremic dysbiosis, which heavily affects microbiota.