title: Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?
abstract: The indications for delaying the start of dialysis have revived interest in low-protein diets (LPDs). In this observational prospective study, we enrolled all patients with chronic kidney disease (CKD) who followed a moderately restricted LPD in 2007-2015 in a nephrology unit in Italy: 449 patients, 847 years of observation. At the start of the diet, the median glomerular filtration rate (GFR) was 20 mL/min, the median age was 70, the median Charlson Index was 7. Standardized mortality rates for the "on-diet" population were significantly lower than for patients on dialysis (United States Renal Data System (USRDS): 0.44 (0.36-0.54); Italian Dialysis Registry: 0.73 (0.59-0.88); French Dialysis Registry 0.70 (0.57-0.85)). Considering only the follow-up at low GFR (≤15 mL/min), survival remained significantly higher than in the USRDS, and was equivalent to the Italian and French registries, with an advantage in younger patients. Below the e-GFR of 15 mL/min, 50% of the patients reached a dialysis-free follow-up of ≥2 years; 25% have been dialysis-free for five years. Considering an average yearly cost of about 50,000 Euros for dialysis and 1200 Euros for the diet, and different hypotheses of "spared" dialysis years, treating 100 patients on a moderately restricted LPD would allow saving one to four million Euros. Therefore, our study suggests that in patients with advanced CKD, moderately restricted LPDs may allow prolonging dialysis-free follow-up with comparable survival to dialysis at a lower cost.
authors.affiliation: Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. gbpiccoli@yahoo.it.|Nephrologie, Centre Hospitalier Le Mans, Le Mans 72000, France. gbpiccoli@yahoo.it.
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.affiliation: Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. marta.nazha@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Nazha
authors.affiliation: Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. irene.capizzi@gmail.com.
authors.forename: Irene
authors.initials: I
authors.lastname: Capizzi
authors.affiliation: Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. fesesnow@inwind.it.
authors.forename: Federica Neve
authors.initials: FN
authors.lastname: Vigotti
authors.affiliation: Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy. elenamongilardi@yahoo.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Mongilardi
authors.affiliation: Obstetrics, Department of Surgery, Città Della Salute e Della Scienza, University of Torino, Torino 10100, Italy. marilisa.biolcati@unito.it.
authors.forename: Marilisa
authors.initials: M
authors.lastname: Bilocati
authors.affiliation: SSD Clinical Nutrition, Department of Clinical and Biological Sciences, ASOU san Luigi, University of Torino, Torino 10100, Italy. paolo.avagnina@unito.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Avagnina
authors.affiliation: SS Epidemiology, Department of Clinical and Biological Sciences, ASOU san Luigi, University of Torino, Torino 10100, Italy. elisabetta.versino@unito.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Versino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018753:Diet, Protein-Restricted / Q000191:economics; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000191:economics; D018450:Disease Progression; D005260:Female; D006801:Humans; D008136:Longevity; D008297:Male; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy*
chemical_list: D004044:Dietary Proteins
keywords: costs; dialysis start; low protein diet; mortality; registry; standardized mortality ratio