Dr.ssa Sofia Cecchi - Dietista, Biologa Nutrizionista

AbstractBACKGROUND AND AIMS. A low-protein diet has shown to be effective in slowing the progression of chronic kidney disease (CKD) and allows a later start to

Sofia Cecchi, Silvio DI Stante, Federica Baldini, Marina DI Luca, MO574: Use of The Highly Hypoproteic Supplemented DIET in the Therapy of Patients With Advanced Chronic Renal Failure, Nephrology Dialysis Transplantation, Volume 37, Issue Supplement_3, May 2022, gfac074.019, https://doi.org/10.1093/ndt/gfac074.019

A low-protein diet has shown to be effective in slowing the progression of chronic kidney disease (CKD) and allows a later start to dialysis treatment [1]. However, the very low protein diet (0.3 g/kg/day) supplemented with aminoacids and ketoanalogues (sVLPD), but it is difficult to implement for the high number of tablets to take [2]. In order to increase compliance, we decided to prescribe balanced sVLPD to all patients with eGFR < 15 mL/min or with specific indications (e.g. renal transplantation program and conservative therapy) supplemented with amino acids without ketoanalogues.

The aim of this approach was to evaluate the efficacy, compliance and safety of the personalized sVLPD, developed by a trainer dietitian mainly focused on nitrogen, acid–base, hydroelectrolytic balances and malnutrition [3].

During last 2 years, 91 patients were initiated into diet therapy. They were 58.2% males, all hypertensive, 33% diabetic, 65.9% on EPO therapy. At the beginning and quarterly were detected characterizing blood chemistry tests, anthropometrich measures and body composition (with impedance analysis) in all the patients.

The average observation time was 9.1 ± 5.1 months. Laboratory tests have shown improvement in mean azotemia (Fig. 1) values (144.2 ± 44.2 versus 94.6 ± 19.7 mg/dL; T0 versus T18; P < 0.005), phosphorus (4.4 ± 0.9 versus 4 ± 0.7 mg/dL; T0 versus T15; P < 0.05), bicarbonate (24.6 ± 5.7 versus 27 ± 4.7 mmol/L; T0 versus T6, P < 0.005); eGFR (Fig. 2) remained stable during follow-up (12.1 ± 3.6 versus 12.4 ± 4 mL/min; T0 versus T18; NS). Hemoglobin, uricemia, serum albumin, glycemia (downward trend NS), potassium, sodium, chlorum, calcium, magnesium, pH and lipids remained within normal values; average TSAT always >20% and average ferritin >100 mg/dL.

The body mass index (BMI) was always on average within the normal range with an increase in patients with adequate hydration and lean mass (Fig. 3); improvement trend (NS) of the PAS, PAD within limits. Reduction of effective protein intake (0.85 ± 0.29 versus 0.61 ± 0.20 g/kg/die; T0 versus T9 P < 0.05). During the observation, 8 deaths occurred (7 patients over 85 years old), 10 admissions on dialysis peritoneal, 4 in hemodialysis and 3 pre-emptive transplants from living donors. To date, we estimated that the initiation of dialysis was delayed on average by 8.7 months/patient.

The approach we have adopted allowed to achieve good adherence to the diet, a slowdown in the progression of the CKD, improve and maintain good metabolic control, electrolytic and acid–base and body composition. A personalized sVLPD resulted in delayed starting of dialysis treatment, allowing patients to continue pre-dialysis education-program, increasing the choice for home peritoneal dialysis.

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