title: Current Uses of Dietary Therapy for Patients with Far-Advanced CKD.
abstract: For several decades, inquiry concerning dietary therapy for nondialyzed patients with CKD has focused mainly on its capability to retard progression of CKD. However, several studies published in recent years indicate that, independent of whether diet can delay progression of CKD, well designed low-protein diets may provide a number of benefits for people with advanced CKD who are close to requiring or actually in need of RRT. Dietary therapy may both maintain good nutritional status and safely delay the need for chronic dialysis in such patients, offering the possibility of improving quality of life and reducing health care costs. With the growing interest in incremental dialysis, dietary therapy may enable lower doses of dialysis to be safely and effectively used, even as GFR continues to decrease. Such combinations of dietary and incremental dialysis therapy might slow the rate of loss of residual GFR, possibly reduce mortality in patients with advanced CKD, improve quality of life, and also, reduce health care costs. The amount of evidence that supports these possibilities is limited, and more well designed, randomized clinical trials are clearly indicated.
authors.affiliation: Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.|Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Norio
authors.initials: N
authors.lastname: Hanafusa
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.|Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bereket Tessema
authors.initials: BT
authors.lastname: Lodebo
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.|Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; and.|UCLA Fielding School of Public Health, Los Angeles, California.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
mesh_terms: D018753:Diet, Protein-Restricted / Q000009:adverse effects; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D011788:Quality of Life; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000178:diet therapy* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chronic; Diet; Health Care Costs; Nutritional Status; Protein-Restricted; Renal Insufficiency; Renal Replacement Therapy; chronic kidney disease; dialysis; essential amino acids; glomerular filtration rate; humans; incremental dialysis; ketoacids; low protein diet; quality of life; renal dialysis; uremia