title: Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?
abstract: Dietary therapy represents an important tool in the management of chronic kidney disease (CKD), mainly through a balanced reduction of protein intake aimed at giving the remnant nephrons in damaged kidneys a "functional rest". While dialysis, transplantation, and pharmacological therapies are usually seen as "high tech" medicine, non pharmacological interventions, including diets, are frequently considered lifestyle-complementary treatments. Diet is one of the oldest CKD treatments, and it is usually considered a part of "mainstream" management. In this narrative review we discuss how the lessons of complementary alternative medicines (CAMs) can be useful for the implementation and study of low-protein diets in CKD. While high tech medicine is mainly prescriptive, prescribing a "good" life-style change is usually not enough and comprehensive counselling is required; the empathic educational approach, on which CAMs are mainly, though not exclusively based, may support a successful personalized nutritional intervention.There is no gold-standard, low-protein diet for all CKD patients: from among a relatively vast choice, the best compliance is probably obtained by personalization. This approach interferes with the traditional RCT-based analyses which are grounded upon an assumption of equal preference of treatments (ideally blinded). Whole system approaches and narrative medicine, that are widely used in the study of CAMs, may offer ways to integrate EBM and personalised medicine in the search for innovative solutions respecting individualization, but gaining sound data, such as with partially-randomised patient preference trials.
authors.affiliation: Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy. gbpiccoli@yahoo.it.|Nephrologie, CH du Mans, Le Mans, France. gbpiccoli@yahoo.it.
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.affiliation: Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy.|Nephrologie, CH du Mans, Le Mans, France.
authors.forename: Irene
authors.initials: I
authors.lastname: Capizzi
authors.affiliation: Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy.|Nephrologie, CH du Mans, Le Mans, France.
authors.forename: Federica Neve
authors.initials: FN
authors.lastname: Vigotti
authors.affiliation: Department of Surgery, SS Dietetics, città della salute e della scienza, University of Torino, Torino, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Leone
authors.affiliation: Department of Experimental and Clinical Medicine, SCDU Nephrology, University of Pisa, Pisa, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: D'Alessandro
authors.affiliation: Department of Surgery, SS Dietetics, città della salute e della scienza, University of Torino, Torino, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Giuffrida
authors.affiliation: Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy.|Nephrologie, CH du Mans, Le Mans, France.
authors.forename: Marta
authors.initials: M
authors.lastname: Nazha
authors.affiliation: Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy.|Nephrologie, CH du Mans, Le Mans, France.
authors.forename: Simona
authors.initials: S
authors.lastname: Roggero
authors.affiliation: Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombi
authors.affiliation: Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mauro
authors.affiliation: Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy.
authors.forename: Natascia
authors.initials: N
authors.lastname: Castelluccia
authors.affiliation: Department of Experimental and Clinical Medicine, SCDU Nephrology, University of Pisa, Pisa, Italy.
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
authors.affiliation: Department of Clinical and Biological Sciences, SSD Clinical Nutrition, ASOU san Luigi, University of Torino, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Avagnina
mesh_terms: D000529:Complementary Therapies; D018753:Diet, Protein-Restricted / Q000379:methods*; D000067269:Diet, Vegan; D037001:Directive Counseling; D000070497:Healthy Lifestyle; D006801:Humans; D016030:Kidney Transplantation; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy* / Q000628:therapy