Compliance, illiteracy and low-protein diet: multiple challenges in CKD and a case of self-empowerment.
BACKGROUND
Low-protein diets (LPD) are an important means of delaying the need for dialysis and attaining a stable metabolic balance in chronic kidney disease (CKD). Many authors consider a low educational level and illiteracy to be adverse features for a good dietary compliance.


METHODS
We report the case of a 77-year old woman, illiterate, affected by advanced CKD (stage 4 according to KDIGO guidelines). She was initially ashamed of her problem and did not declare it, leading to an overzealous reduction in protein intake. However, with her daughter's help, who translated the dietary prescription into images, she overcame the barrier represented by illiteracy and was able to correctly follow the prescriptions, attaining good kidney function stability and preserving an adequate nutritional status.


CONCLUSIONS
The case underlines the importance of a personalized approach to dietary prescriptions and suggests that it is possible to achieve a good compliance to the dietary treatment of CKD also in patients with relevant cultural barriers.
SC Nephrology and Dialysis, Brotzu Hospital, Piazzale Alessandro Ricchi 1, 09134, Cagliari, Italy.
Stefania
S
Maxia
SC Nephrology and Dialysis, Brotzu Hospital, Piazzale Alessandro Ricchi 1, 09134, Cagliari, Italy.
Valentina
V
Loi
SS Nephrology, SCDU Urologia, Department of Clinical and Biological Sciences, University of Torino, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy.
Irene
I
Capizzi
SS Nephrology, SCDU Urologia, Department of Clinical and Biological Sciences, University of Torino, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy.|Nephrologie, Centre Hospitalier Le Mans, 194 av. Rubillard, 72037, Le Mans, France.
Giorgina Barbara
GB
Piccoli
SC Nephrology and Dialysis, Brotzu Hospital, Piazzale Alessandro Ricchi 1, 09134, Cagliari, Italy. gianfranca.cabiddu@tin.it.
Gianfranca
G
Cabiddu
SC Nephrology and Dialysis, Brotzu Hospital, Piazzale Alessandro Ricchi 1, 09134, Cagliari, Italy.
Antonello
A
Pani
Case report; Chronic kidney disease; Compliance; Illiteracy; Low protein diet
J Am Diet Assoc. 1995 Nov;95(11):1295-300
7594126
Nephron Clin Pract. 2014;126(1):1-7
24434650
J Dent Res. 2007 Dec;86(12):1171-5
18037650
N Engl J Med. 2006 Jul 27;355(4):339-41
16870912
Diabetes Educ. 2014 Sep-Oct;40(5):688-99
24942530
Nephrol Dial Transplant. 2013 Sep;28(9):2295-305
23751187
Br J Nutr. 2014 Jun 28;111(12):2184-9
24636006
Br J Nutr. 2015 Mar 28;113(6):963-74
25744160
J Ren Nutr. 2013 Jul;23(4):271-6
23131574
Annu Rev Nutr. 2009;29:341-64
19575595
Am J Gastroenterol. 2014 Sep;109(9):1304-11
24980880
J Ren Nutr. 2013 May;23(3):164-71
23194841
J Fam Pract. 1990 Nov;31(5):533-8
2230677
J Am Soc Nephrol. 2004 Jan;15(1):234-7
14694178
Nat Clin Pract Nephrol. 2007 Oct;3(10):E1; author reply E2
17895928
J Ren Nutr. 2013 Mar;23(2):e43-6
23337089
Am J Kidney Dis. 2015 Jun;65(6):814-6
26003608
J Family Community Med. 2012 Jan;19(1):26-32
22518355
Gen Hosp Psychiatry. 2014 Nov-Dec;36(6):662-8
25103544
Am J Kidney Dis. 2015 Jun;65(6):842-50
25661679
Clin Kidney J. 2015 Feb;8(1):61-70
25713712
Nephrology (Carlton). 2006 Feb;11(1):58-62
16509934
Br J Nutr. 2015 Apr 14;113(7):1139-47
25784199
Kidney Int. 1985 Jan;27(1):58-65
3981873
Med Sci Monit. 2016 Apr 08;22:1171-9
27056188
Nat Clin Pract Nephrol. 2007 Jul;3(7):383-92
17592471
J Hum Nutr Diet. 2015 Feb;28 Suppl 2:24-32
25220046
Br J Nutr. 2014 Apr 14;111(7):1303-12
24330831
J Periodontol. 2014 Jul;85(7):899-907
24215204