title: Low-Protein Diets in Diabetic Chronic Kidney Disease (CKD) Patients: Are They Feasible and Worth the Effort?
abstract: Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan-Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%,p= 0.002) as well as comorbidity (median Charlson index 8 vs. 6p= 0.002). Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups): about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate) < 15 mL/min, and 1 year after reaching e-GFR < 10 mL/min. In patients with type 2 diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity.
authors: Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. gbpiccoli@yahoo.it.|Nephrologie, Centre Hospitalier Le Mans, Le Mans 72100, France. gbpiccoli@yahoo.it.
authors: Giorgina B
authors: GB
authors: Piccoli
authors: SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. federica.ventrella@edu.unito.it.
authors: Federica
authors: F
authors: Ventrella
authors: SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. irene.capizzi@gmail.com.
authors: Irene
authors: I
authors: Capizzi
authors: SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. fedesnow@inwind.it.
authors: Federica N
authors: FN
authors: Vigotti
authors: SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. elenamongilardi@yahoo.it.
authors: Elena
authors: E
authors: Mongilardi
authors: SCDU Endocrinologia, Diabetologia e Metabolismo, Città della Salute e della Scienza Torino, Torino 10100, Italy. ggrassi@cittadellasalute.to.it.
authors: Giorgio
authors: G
authors: Grassi
authors: SC Nefrologia, Brotzu Hospital, Cagliari 09134, Italy. valentina.loi@aol.com.
authors: Valentina
authors: V
authors: Loi
authors: SC Nefrologia, Brotzu Hospital, Cagliari 09134, Italy. gianfranca.cabiddu@tin.it.
authors: Gianfranca
authors: G
authors: Cabiddu
authors: SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. paolo.avagnina@unito.it.
authors: Paolo
authors: P
authors: Avagnina
authors: SSD Epidemiology, Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. elisabetta.versino@unito.it.
authors: Elisabetta
authors: E
authors: Versino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000178:diet therapy* / Q000209:etiology / Q000401:mortality; D018753:Diet, Protein-Restricted; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000453:epidemiology / Q000209:etiology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy* / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D004044:Dietary Proteins; D003404:Creatinine
keywords: chronic kidney disease; diabetes; diabetic nephropathy; dialysis start; low-protein diets; patient survival