title: North American experience with Low protein diet for Non-dialysis-dependent chronic kidney disease.
abstract: Whereas in many parts of the world a low protein diet (LPD, 0.6-0.8 g/kg/day) is routinely prescribed for the management of patients with non-dialysis-dependent chronic kidney disease (CKD), this practice is infrequent in North America. The historical underpinnings related to LPD in the USA including the non-conclusive results of the Modification of Diet in Renal Disease Study may have played a role. Overall trends to initiate dialysis earlier in the course of CKD in the US allowed less time for LPD prescription. The usual dietary intake in the US includes high dietary protein content, which is in sharp contradistinction to that of a LPD. The fear of engendering or worsening protein-energy wasting may be an important handicap as suggested by a pilot survey of US nephrologists; nevertheless, there is also potential interest and enthusiasm in gaining further insight regarding LPD's utility in both research and in practice. Racial/ethnic disparities in the US and patients' adherence are additional challenges. Adherence should be monitored by well-trained dietitians by means of both dietary assessment techniques and 24-h urine collections to estimate dietary protein intake using urinary urea nitrogen (UUN). While keto-analogues are not currently available in the USA, there are other oral nutritional supplements for the provision of high-biologic-value proteins along with dietary energy intake of 30-35 Cal/kg/day available. Different treatment strategies related to dietary intake may help circumvent the protein- energy wasting apprehension and offer novel conservative approaches for CKD management in North America.
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA. kkz@uci.edu.|Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA. kkz@uci.edu.|Department Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA. kkz@uci.edu.|Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA. kkz@uci.edu.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Linda W
authors.initials: LW
authors.lastname: Moore
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Tortorici
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.|Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Chou
authors.affiliation: Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: St-Jules
authors.affiliation: Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
authors.forename: Arianna
authors.initials: A
authors.lastname: Aoun
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rojas-Bautista
authors.affiliation: Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA.
authors.forename: Annelle K
authors.initials: AK
authors.lastname: Tschida
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.|Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Rhee
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: Anuja A
authors.initials: AA
authors.lastname: Shah
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Crowley
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.|National Kidney Foundation, Inc., New York, NY, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vassalotti
authors.affiliation: University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
mesh_terms: D001741:Black or African American; D001291:Attitude of Health Personnel; D018753:Diet, Protein-Restricted / Q000706:statistics & numerical data*; D004044:Dietary Proteins / Q000008:administration & dosage*; D019587:Dietary Supplements; D002149:Energy Intake; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino; D006801:Humans; D015596:Nutrition Assessment; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy*; D014481:United States; D044465:White People
chemical_list: D004044:Dietary Proteins
keywords: CKD; Dietary protein intake; Dietary restriction; Low protein diet; Nutritional management