title: Low-protein vegetarian diet with alpha-chetoanalogues prior to pre-emptive pancreas-kidney transplantation.
abstract: BACKGROUND
  Pre-emptive pancreas-kidney transplantation is increasingly considered the best therapy for irreversible chronic kidney disease (CKD) in type 1 diabetics. However, the best approach in the wait for transplantation has not yet been defined.
  
  
  OBJECTIVE
  To evaluate our experience with a low-protein (0.6 g/kg/day) vegetarian diet supplemented with alpha-chetoanalogues in type 1 diabetic patients in the wait for pancreas-kidney transplantation.
  
  
  METHODS
  Prospective study. Information on the progression of renal disease, compliance, metabolic control, reasons for choice and for drop-out were recorded prospectively; the data for the subset of patients who underwent the diet while awaiting a pancreas-kidney graft are analysed in this report.
  
  
  RESULTS
  From November 1998 to April 2004, 9 type 1 diabetic patients, wait-listed or performing tests for wait-listing for pancreas-kidney transplantation, started the diet. All of them were followed by nephrologists and diabetologists, in the context of integrated care. There were 4 males and 5 females; median age 38 years (range 27.9-45.5); median diabetes duration 23.8 years (range 16.6-33.1), 8/9 with widespread organ damage; median creatinine at the start of the diet: 3.2 mg/dl (1.2-7.2); 4 patients followed the diet to transplantation, 2 are presently on the diet, 2 dropped out and started dialysis after a few months, 1 started dialysis (rescue treatment). The nutritional status remained stable, glycemia control improved in 4 patients in the short term and in 2 in the long term, no hyperkalemia, acidosis or other relevant side effect was recorded. Proteinuria decreased in 5 cases, in 3 from the nephrotic range. Albumin levels remained stable; the progression rate was a loss of 0.47 ml/min of creatinine clearance per month (ranging from an increase of 0.06 to a decrease of 2.4 ml/min) during the diet period (estimated by the Cockroft-Gault formula).
  
  
  CONCLUSIONS
  Low-protein supplemented vegetarian diets may be a useful tool to slow CKD progression whilst awaiting pancreas-kidney transplantation.
authors.affiliation: Department of Internal Medicine, University of Turin, Corso Dogliotti 16, 10126 Torino, Italy. giorgina.piccoli@unito.it
authors.forename: Giorgina B
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Daria
authors.initials: D
authors.lastname: Motta
authors.forename: Guido
authors.initials: G
authors.lastname: Martina
authors.forename: Valentina
authors.initials: V
authors.lastname: Consiglio
authors.forename: Massimo
authors.initials: M
authors.lastname: Gai
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Mezza
authors.forename: Emanuela
authors.initials: E
authors.lastname: Maddalena
authors.forename: Manuel
authors.initials: M
authors.lastname: Burdese
authors.forename: Loredana
authors.initials: L
authors.lastname: Colla
authors.forename: Fabio
authors.initials: F
authors.lastname: Tattoli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Anania
authors.forename: Maura
authors.initials: M
authors.lastname: Rossetti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Soragna
authors.forename: Giorgio
authors.initials: G
authors.lastname: Grassi
authors.forename: Franco
authors.initials: F
authors.lastname: Dani
authors.forename: Alberto
authors.initials: A
authors.lastname: Jeantet
authors.forename: Giuseppe P
authors.initials: GP
authors.lastname: Segoloni