Very low-protein diet can delay the need for dialysis in patients with chronic kidney disease (CKD)

Chronic kidney disease (CKD) is a general condition characterised by a varying degree of kidney impairment. One in 10 European adults suffers with CKD, which has no cure and progressively worsens over time if adequate lifestyle changes are not made and treatments not given. This can lead to end-stage disease and kidney failure, requiring dialysis and an eventual transplant.

The ERA-EDTA (European Renal Nutrition Working Group of the European Renal Association – European Dialysis and Transplant Association) has published commentary on the advantages of a very low protein diet in CKD patients. In patients with CKD, toxic metabolic waste products accumulate in the blood as the kidneys are not working efficiently enough, leading to an accelerated rate of renal failure.

Utilising a low protein diet can lead to substantial improvements in uraemic disorders, where excess urea is in the blood as a result of kidney failure. According to the paper, blood pressure, serum phosphate and albuminuria were all reduced when on the low protein diet, which involved consuming only 0.3?0.4 grams of protein per kilogram of bodyweight.

• The low protein diet contains less phosphate, therefore serum phosphate levels were significantly reduced.
• Proteinuria was reduced as lower protein consumption results in less protein in the blood and therefore less protein in the urine.
• It instigated a sustained fall in blood pressure in advanced CKD patients with uncontrolled hypertension.
• It improved metabolic control in moderate to advanced patients, reducing uraemia, delaying the need for dialysis by an average of 1 year and reduced cardiovascular complications.

‘We have to start the nutritional treatment early in CKD and implement a low-protein diet, or even better, a very low-protein diet supplemented with ketoanalogues, in CKD patients right from the beginning, which means in patients whose glomerular filtration rate has dropped below 60 ml/min/1.73 m²’, explains Professor Denis Fouque, president of the ERN (abbr: European Renal Nutrition Working Group). ‘The very low protein diet is basically a vegetarian diet supplemented with ketoanalogues, which have the capacity to lower blood urea concentration’.

There are drawbacks to this diet, for example protein-energy wasting can occur which is one of the biggest mortality risk factors in CKD patients, therefore the authors supplemented the diet with ketoanalogues and ensured sufficient energy intake. They stated that this diet is only appropriate for well-nourished patients without many other comorbidities. ‘In these patients it is highly effective, at least when patients adhere to the diet’ explains Professor Bellizzi, first author of the study.