Chronic Kidney Disease (CKD)

CKD is defined as abnormalities of kidney structure or function present for  > 3 months, with implications for health with either of the following criteria : presence of markers of kidney damage (one or more) or decreased glomerular filtration rate.

Complications of CKD affect all organ systems (cardiovascular disease, hypertension, anemia, malnutrition, bone disease, neuropathy and decreased quality of life.

The proportion of people with important antecedents to CKD, such as diabetes, is growing alarmingly worldwide in both developed and developing countries.

 

Low protein diet in CKD (stages 3-5 chronic)

Low protein diets can delay kidney failure in people with kidney disease (diabetic kidney disease excluded). A diet low in protein is sometimes recommended to try to slow the progression of kidney disease.

Diet plays a major role in the progression and complications of predialysis CKD. Moderate protein consumption along with a diet low in sodium might slow kidney disease progression.

Low protein diet is associated with markedly reduced urinary urea nitrogen output and a concomitant decrease in kidney workload. The current recommendation is to lower protein intake to 0.6g – 0.8g /kg/day in adults with appropriate nutritional education and follow up. Further restriction up to 0.3g/kg/day are feasible but need to be supplemented with essential amino acid and strictly under medical surveillance.

Patients with CKD should adhere to a detailed dietary care plan during their entire lifetime.  A nutritional survey is highly recommended to verify that sufficient energy is provided to the patients during modification of protein intake.

The use of low protein products is useful in building a dietary plan because they allow to provide good amount of energy without harmful nutrients (for instance the ration energy/phosphorus –> it is possible to give 8 times more energy with the same level of phosphorus in the pasta) and delay the renal death.

Diet, for which compliance is key to success, is highly intrusive in a patient’s life. It is difficult to achieve if diet is too rigid.