A practical approach to low protein diets for patients with chronic kidney disease in Cameroon.
Cameroon is a low-middle income country with a rich diversity of culture and cuisine. Chronic kidney disease (CKD) is common in Cameroon and over 80 % of patients present late for care, precluding the use of therapies such as low protein diets (LPDs) that slow its progression. Moreover, the prescription of LPDs is challenging in Cameroon because dieticians are scarce, there are no renal dieticians, and people often have to fund their own healthcare. The few nephrologists that provide care for CKD patients have limited expertise in LPD design. Therefore, only moderate LPDs of 0.6 g protein per kg bodyweight per day, or relatively mild LPDs of 0.7-0.8 g protein per kg bodyweight per day are prescribed. The moderate LPD is prescribed to patients with stage 3 or 4 CKD with non-nephrotic proteinuria, no evidence of malnutrition and no interrcurrent acute illnesses. The mild LPD is prescribed to patients with stage 3 or 4 CKD with nephrotic proteinuria, non-symptomatic stage 5 CKD patients or stage 5 CKD patients on non-dialysis treatment. In the absence of local sources of amino and keto acid supplements, traditional mixed LPDs are used. For patients with limited and sporadic access to animal proteins, the prescribed LPDs do not restrict vegetable proteins, but limit intake of animal proteins (when available) to 70 % of total daily protein intake. For those with better access to animal proteins, the prescribed LPDs limit intake of animal proteins to 50-70 % of total daily protein intake, depending on their meal plan. Images of 100 g portions of meat, fish and readily available composite meals serve as visual guides of quantities for patients. Nutritional status is assessed before LPD prescription and during follow up using a subjective global assessment and serum albumin. In conclusion, LPDs are underutilised and challenging to prescribe in Cameroon because of weakness in the health system, the rarity of dieticians, a wide diversity of dietary habits, the limited nutritional expertise of nephrologists and the unavailability of amino and keto acid supplements.
Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. maglo09@hotmail.com.
Gloria Enow
GE
Ashuntantang
Douala General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Hermine
H
Fouda
University Teaching Hospital Yaounde & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Francois Folefack
FF
Kaze
Douala General Hospital & Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
Marie-Patrice
MP
Halle
Yaounde Central Hospital, Yaounde, Cameroon.
Crista
C
Tabi-Arrey
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
Magloire
M
Biwole-Sida
D000596:Amino Acids / Q000008:administration & dosage / Q000600:supply & distribution; D002163:Cameroon; D002983:Clinical Competence; D003906:Developing Countries; D018753:Diet, Protein-Restricted / Q000379:methods* / Q000706:statistics & numerical data*; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000600:supply & distribution; D019587:Dietary Supplements / Q000706:statistics & numerical data / Q000600:supply & distribution; D004046:Dietetics; D005247:Feeding Behavior; D006801:Humans; D007651:Keto Acids / Q000008:administration & dosage / Q000600:supply & distribution; D015596:Nutrition Assessment; D009752:Nutritional Status; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy*; D000078329:Workforce
D000596:Amino Acids; D004044:Dietary Proteins; D007651:Keto Acids
Africa; Cameroon; Chronic kidney disease; Low protein diets