%0 Journal Article
%T Moderate Protein Restriction in Advanced CKD: A Feasible Option in An Elderly, High-Comorbidity Population. A Stepwise Multiple-Choice System Approach
%A Ana Kaniassi
%A Antioco Fois
%A Antoine Chatrenet
%A Elena Mongilardi
%A Elisabetta Versino
%A Emanuela Cataldo
%A Francoise Lippi
%A Giorgina Barbara Piccoli
%A Irene Capizzi
%A Jerome Vigreux
%A Ludivine Froger
%A Marilisa Biolcati
%J Archive of "Nutrients".
%D 2019
%R 10.3390/nu11010036
%X Background: Protein restriction may retard the need for renal replacement therapy; compliance is considered a barrier, especially in elderly patients. Methods: A feasibility study was conducted in a newly organized unit for advanced kidney disease; three diet options were offered: normalization of protein intake (0.8 g/kg/day of protein); moderate protein restriction (0.6 g/kg/day of protein) with a ※traditional§ mixed protein diet or with a ※plant-based§ diet supplemented with ketoacids. Patients with protein energy wasting (PEW), short life expectancy or who refused were excluded. Compliance was estimated by Maroni-Mitch formula and food diary. Results: In November 2017每July 2018, 131 patients started the program: median age 74 years (min每max 24-101), Charlson Index (CCI): 8 (min-max: 2每14); eGFR 24 mL/min (4每68); 50.4% were diabetic, BMI was ≡ 30 kg/m2 in 40.4%. Normalization was the first step in 75 patients (57%, age 78 (24每101), CCI 8 (2每12), eGFR 24 mL/min (8每68)); moderately protein-restricted traditional diets were chosen by 24 (18%, age 74 (44每91), CCI 8 (4每14), eGFR 22 mL/min (5每40)), plant-based diets by 22 (17%, age 70 (34每89), CCI 6.5 (2每12), eGFR 15 mL/min (5每46)) (p < 0.001). Protein restriction was not undertaken in 10 patients with short life expectancy. In patients with ≡ 3 months of follow-up, median reduction of protein intake was from 1.2 to 0.8 g/kg/day (p < 0.001); nutritional parameters remained stable; albumin increased from 3.5 to 3.6 g/dL (p = 0.037); good compliance was found in 74%, regardless of diets. Over 1067 patient-months of follow-up, 9 patients died (CCI 10 (6每12)), 7 started dialysis (5 incremental). Conclusion: Protein restriction is feasible by an individualized, stepwise approach in an overall elderly, high-comorbidity population with a baseline high-protein diet and is compatible with stable nutritional status
%K chronic kidney disease
%K protein restriction
%K protein intake
%K obesity
%K diabetes
%K compliance
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356994/