title: Effect of personalized dietary intervention on nutritional, metabolic and vascular indices in patients with chronic kidney disease.
abstract: OBJECTIVE
  Patients with chronic kidney disease (CKD) present a markedly increased cardiovascular (CV) morbidity and mortality since the early stages of the disease and a high prevalence of malnutrition, inflammation, and accelerated atherosclerosis. Personalized nutritional intervention, with of a low-protein diet (LPD), since the early stages of CKD should be able to achieve significant metabolic improvements. In our study we have verified the effects of a personalized dietary intervention in patients in the CKD stages 3/4 KDOQI on nutritional, metabolic and vascular indices.
  
  
  METHODS
  We have evaluated renal function, lipid profile, mineral metabolism, inflammatory indices, and acid-base balance of 16 patients with CKD (stages 3/4 KDOQI). Assessment of nutritional status, body composition, bone mineral density and muscle mass, using body mass index (BMI), handgrip strength, bioelectrical impedance analysis (BIA), and dual energy X-ray absorptiometry (DEXA) was performed. Vascular indices and endothelial dysfunction such as carotid intima-media thickness (cIMT) and the brachial artery flow-mediated dilation (baFMD) were also analyzed.
  
  
  RESULTS
  After dietary interventions, we observed a significant increase in plasma bicarbonate (p = 0.004) and vitamin D levels (p = 0.03) and a concomitant significant reduction of phosphorus concentration (p = 0.001) and C-reactive protein (CRP) (p = 0.01).
  
  
  CONCLUSIONS
  Nutritional intervention potentially plays a major role in reducing the progression of CKD and systemic complications of predialysis patients. A low-protein diet (LPD) ensuring vegetable protein intake and a reduced amount of specific micronutrients should be recommended to stage 3/4 CKD patients in order to ameliorate metabolic profile, renal outcome, and reduce cardiovascular risk factors.
authors.affiliation: Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy. silvia.lai@uniroma1.it.
authors.forename: S
authors.initials: S
authors.lastname: Lai
authors.forename: A
authors.initials: A
authors.lastname: Molfino
authors.forename: B
authors.initials: B
authors.lastname: Coppola
authors.forename: S
authors.initials: S
authors.lastname: De Leo
authors.forename: V
authors.initials: V
authors.lastname: Tommasi
authors.forename: A
authors.initials: A
authors.lastname: Galani
authors.forename: S
authors.initials: S
authors.lastname: Migliaccio
authors.forename: E A
authors.initials: EA
authors.lastname: Greco
authors.forename: T
authors.initials: T
authors.lastname: Gnerre Musto
authors.forename: M
authors.initials: M
authors.lastname: Muscaritoli
mesh_terms: D000138:Acidosis / Q000378:metabolism*; D001823:Body Composition; D004032:Diet / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D053858:Metabolic Networks and Pathways; D008875:Middle Aged; D009752:Nutritional Status; D051436:Renal Insufficiency, Chronic / Q000097:blood*; D012307:Risk Factors; D014652:Vascular Diseases