[Low-protein diet and nutritional status].
Low-protein diets (LPDs) are most useful to control uremic symptoms, but the fear of malnutrition is still an issue. Thanks to commercially available low-protein preparations, reducing the protein intake to 0.6 mg/kg/day and even 0.3 mg/kg/day (very low-protein diets, VLPDs) is quite easy. However, providing palatable low-protein diets without disrupting the patient's lifestyle may not be as easy as reducing the protein intake. The risk is a low compliance with the dietary prescription, resulting in reduction of calorie intake and malnutrition. The risk is even higher in patients beginning dialysis, for some degree of malnutrition is frequent in such subjects. Preserving an adequate nutritional situation is feasible for a long time in LPD-treated and VLPD-treated kidney patients independently of age and diabetes, as demonstrated by the MDRD study. Careful follow-up of protein and calorie intake as well as nutritional status is, however, required. Several anthropometric, laboratory, clinical, and bioelectrical impedance indices are available for follow-up. Moderate yet steady physical activity is highly advisable in patients with progressive renal disease.
Filippini
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Centro di Riferimento Regionale di Nefrologia e Dialisi, Ospedale San Giacomo, Via Predoi 98, Rome, Italy. covoni@libero.it
D018753:Diet, Protein-Restricted / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors