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Nutritional Approach for Patients with Advanced CKD

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 September 2021) | Viewed by 43013

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Special Issue Editor

Prof. Dr. Adamasco Cupisti

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Guest Editor

Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
Interests: chronic kidney disease; renal nutrition; kidney stones disease; phosphate; dialysis; dietary protein

Special Issue Information

Dear Colleagues,

Dietetic-nutritional therapy is an important component of conservative management care for patients suffering from chronic kidney disease. This factor is becoming more and more relevant in the advanced stages of CKD when it is crucial to delay or even avoid the beginning of dialysis treatment.

In particular, proper nutritional treatment may be very important when the patient is included in a pre-emptive kidney transplant program to delay the need for dialysis, providing greater opportunity to effectively achieve pre-emptive transplantation.

The recent KDOQI guidelines support the implementation of nutritional treatment for CKD, but concerns about the safety and applicability of low-protein regimes still prevent the widespread use of protein-restricted regimens in clinical practice.

An interdisciplinary and multi-professional approach is necessary for patient-centred and patient-shared treatments to give the highest chance of success and safety.

This Special Issue aims to present a collection of papers that report clinical experiences and different nutritional treatment strategies for patients with advanced stage CKD, including those in pre-emptive transplant programs and those with infrequent or incremental dialysis schedules.

Prof. Dr. Adamasco Cupisti
Guest Editor

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Keywords

chronic kidney disease
low protein diet
incremental dialysis
infrequent dialysis
pre-emptive kidney transplant
nutritional status
diet
kidney disease progression

Published Papers (6 papers)

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Research

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11 pages, 277 KiB

Open AccessArticle

Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet

by Andreana De Mauri, Deborah Carrera, Matteo Vidali, Marco Bagnati, Roberta Rolla, Sergio Riso, Massimo Torreggiani and Doriana Chiarinotti

Nutrients 2022, 14(3), 487; https://doi.org/10.3390/nu14030487 - 23 Jan 2022

Cited by 7 | Viewed by 3358

Abstract

Background. In medicine, “compliance” indicates that the patient complies with the prescriber’s recommendations, “adherence” means that “the patient matches the recommendations” and “concordance” means “therapeutic alliance” between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. Patients. Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A₂ (Lp-PLA₂) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. Results. nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA₂, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. Conclusion. This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in “adherent” and “concordant” patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions. Full article

(This article belongs to the Special Issue Nutritional Approach for Patients with Advanced CKD)

12 pages, 943 KiB

Open AccessArticle

Energy Requirement for Elderly CKD Patients

by Claudia D’Alessandro, Domenico Giannese, Monica Avino and Adamasco Cupisti

Nutrients 2021, 13(10), 3396; https://doi.org/10.3390/nu13103396 - 27 Sep 2021

Cited by 5 | Viewed by 3005

Abstract

The correct management of energy intake is crucial in CKD (chronic kidney disease) patients to limit the risk of protein energy wasting especially during low-protein regimes, but also to prevent overweight/obesity. The aim of this study was to assess the energy requirement of older CKD patients using objective measurements. This cross-sectional study enrolled 67 patients (aged 60–86 years) with CKD stages 3–5 not on dialysis, all of whom were metabolically and nutritionally stable. All patients underwent indirect calorimetry and measurement of daily physical activity level expressed by the average daily Metabolic Equivalent Task, using an accelerometer, in order to measure total energy expenditure (mTEE). Estimated TEE (eTEE) was derived from predictive equations for resting energy expenditure and physical activity levels coefficients. The mTEE were lower than eTEE-based on Harris–Benedict or Schofield or Mifflin equations (1689 ± 523 vs. 2320 ± 434 or 2357 ± 410 or 2237 ± 375 Kcal, p < 0.001, respectively). On average mTEE was 36.5% lower than eTEE. When eTEE was recalculated using ideal body weight the gap between mTEE and eTEE was reduced to 26.3%. A high prevalence of a sedentary lifestyle and reduced physical capabilities were also detected. In conclusion, our data support the energy intake of 25–35 Kcal/Kg/d recently proposed by the NKF-KDOQI (National Kidney Foundation-Kidney Disease Improving Quality Initiative) guidelines on nutritional treatment of CKD, which seem to be more adequate and applicable than that of previous guidelines (30–35 Kcal/Kg/d) in elderly stable CKD patients with a sedentary lifestyle. According to our findings we believe that an energy intake even lower than 25 Kcal/Kg/d may be adequate in metabolically stable, elderly CKD patients with a sedentary lifestyle. Full article

(This article belongs to the Special Issue Nutritional Approach for Patients with Advanced CKD)

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14 pages, 450 KiB

Open AccessArticle

Quality of Life in CKD Patients on Low-Protein Diets in a Multiple-Choice Diet System. Comparison between a French and an Italian Experience

by Antioco Fois, Massimo Torreggiani, Tiziana Trabace, Antoine Chatrenet, Elisa Longhitano, Béatrice Mazé, Francoise Lippi, Jerome Vigreux, Coralie Beaumont, Maria Rita Moio and Giorgina Barbara Piccoli

Nutrients 2021, 13(4), 1354; https://doi.org/10.3390/nu13041354 - 18 Apr 2021

Cited by 13 | Viewed by 2518

Abstract

Prescribing a low-protein diet (LPD) is part of the standard management of patients in advanced stages of chronic kidney disease (CKD). However, studies on the quality of life (QoL) of patients on LPDs are lacking, and the impact these diets have on their QoL is often given as a reason for not prescribing one. We, therefore, decided to assess the QoL in a cohort of CKD stage 3–5 patients followed up by a multiple-choice diet approach in an outpatient nephrology clinic in France. To do so, we used the short version of the World Health Organization’s quality of life questionnaire and compared the results with a historical cohort of Italian patients. We enrolled 153 patients, managed with tailored protein restriction in Le Mans, and compared them with 128 patients on similar diets who had been followed in Turin (Italy). We found there were no significant differences in terms of age (median 73 vs. 74 years, respectively), gender, CKD stage, and comorbidities (Charlson’s Comorbidity Index 7 vs. 6). French patients displayed a greater body mass index (29.0 vs. 25.4, p < 0.001) and prevalence of obesity (41.2 vs. 15.0%, p < 0.001). Baseline protein intake was over the target in France (1.2 g/kg of real body weight/day). In both cohorts, the burden of comorbidities was associated with poorer physical health perception while kidney function was inversely correlated to satisfaction with social life, independently of the type of diet. Our study suggests that the type of LPD they follow does not influence QoL in CKD patients and that a personalized approach towards protein restriction is feasible, even in elderly patients. Full article

(This article belongs to the Special Issue Nutritional Approach for Patients with Advanced CKD)

Review

Jump to: Research

19 pages, 2308 KiB

Open AccessReview

Ketoanalogue Supplementation in Patients with Non-Dialysis Diabetic Kidney Disease: A Systematic Review and Meta-Analysis

by Vincenzo Bellizzi, Carlo Garofalo, Carmela Ferrara and Patrizia Calella

Nutrients 2022, 14(3), 441; https://doi.org/10.3390/nu14030441 - 19 Jan 2022

Cited by 9 | Viewed by 8509

Abstract

The effects of supplemental ketoanalogues (KA) in patients with diabetic kidney disease (DKD) are not well characterized. Several databases for peer-reviewed articles were systematically searched to identify studies reporting outcomes associated with the effects of a low-protein diet (LPD) or very-low protein diet (VLPD) in combination with supplemental KA in adults with DKD. Meta-analyses were conducted when feasible. Of 213 identified articles, 11 could be included in the systematic review. Meta-analyses for renal outcomes (4 studies examining glomerular filtration rate; 5 studies examining 24-h urinary protein excretion), metabolic outcomes (5 studies examining serum urea; 7 studies examining blood glucose), clinical outcomes (6 studies examining blood pressure; 4 studies examining hemoglobin), and nutritional outcomes (3 studies examining serum albumin; 4 studies examining body weight) were all in favor of KA use in DKD patients. Data from individual studies that examined other related parameters also tended to show favorable effects from KA-supplemented LPD/VLPD. The regimens were safe and well tolerated, with no evidence of adverse effects on nutritional status. In conclusion, LPD/VLPD supplemented with KA could be considered effective and safe for patients with non-dialysis dependent DKD. Larger studies are warranted to confirm these observations. Full article

(This article belongs to the Special Issue Nutritional Approach for Patients with Advanced CKD)

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25 pages, 1799 KiB

Open AccessFeature PaperReview

Interactions between Food and Drugs, and Nutritional Status in Renal Patients: A Narrative Review

by Claudia D’Alessandro, Alessia Benedetti, Antonello Di Paolo, Domenico Giannese and Adamasco Cupisti

Nutrients 2022, 14(1), 212; https://doi.org/10.3390/nu14010212 - 4 Jan 2022

Cited by 9 | Viewed by 12226

Abstract

Drugs and food interact mutually: drugs may affect the nutritional status of the body, acting on senses, appetite, resting energy expenditure, and food intake; conversely, food or one of its components may affect bioavailability and half-life, circulating plasma concentrations of drugs resulting in an increased risk of toxicity and its adverse effects, or therapeutic failure. Therefore, the knowledge of these possible interactions is fundamental for the implementation of a nutritional treatment in the presence of a pharmacological therapy. This is the case of chronic kidney disease (CKD), for which the medication burden could be a problem, and nutritional therapy plays an important role in the patient’s treatment. The aim of this paper was to review the interactions that take place between drugs and foods that can potentially be used in renal patients, and the changes in nutritional status induced by drugs. A proper definition of the amount of food/nutrient intake, an adequate definition of the timing of meal consumption, and a proper adjustment of the drug dosing schedule may avoid these interactions, safeguarding the quality of life of the patients and guaranteeing the effectiveness of drug therapy. Hence, a close collaboration between the nephrologist, the renal dietitian, and the patient is crucial. Dietitians should consider that food may interact with drugs and that drugs may affect nutritional status, in order to provide the patient with proper dietary suggestions, and to allow the maximum effectiveness and safety of drug therapy, while preserving/correcting the nutritional status. Full article

(This article belongs to the Special Issue Nutritional Approach for Patients with Advanced CKD)

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18 pages, 726 KiB

Open AccessReview

Nutritional Approaches for the Management of Metabolic Acidosis in Chronic Kidney Disease

by Annalisa Noce, Giulia Marrone, Georgia Wilson Jones, Manuela Di Lauro, Anna Pietroboni Zaitseva, Linda Ramadori, Roberto Celotto, Anna Paola Mitterhofer and Nicola Di Daniele

Nutrients 2021, 13(8), 2534; https://doi.org/10.3390/nu13082534 - 24 Jul 2021

Cited by 21 | Viewed by 12327

Abstract

Metabolic acidosis is a severe complication of chronic kidney disease (CKD) which is associated with nefarious impairments such as bone demineralization, muscle wasting, and hormonal alterations, for example, insulin resistance. Whilst it is possible to control this condition with alkali treatment, consisting in the oral administration of sodium citrate or sodium bicarbonate, this type of intervention is not free from side effects. On the contrary, opting for the implementation of a targeted dietetic-nutritional treatment for the control of CKD metabolic acidosis also comes with a range of additional benefits such as lipid profile control, increased vitamins, and antioxidants intake. In our review, we evaluated the main dietary-nutritional regimens useful to counteract metabolic acidosis, such as the Mediterranean diet, the alkaline diet, the low-protein diet, and the vegan low-protein diet, analyzing the potentialities and limits of every dietary-nutritional treatment. Literature data suggest that the Mediterranean and alkaline diets represent a valid nutritional approach in the prevention and correction of metabolic acidosis in CKD early stages, while the low-protein diet and the vegan low-protein diet are more effective in CKD advanced stages. In conclusion, we propose that tailored nutritional approaches should represent a valid therapeutic alternative to counteract metabolic acidosis. Full article

(This article belongs to the Special Issue Nutritional Approach for Patients with Advanced CKD)

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