Advanced CKD Patients May Benefit From Dietary Therapy

Dietary therapy may benefit patients with advanced chronic kidney disease (CKD) transitioning to renal replacement therapy (RRT) or actually in need of RRT, according to the authors of a new review published in the Clinical Journal of the American Society of Nephrology.

Tailored renal diets potentially reduce the retention of sodium, potassium, phosphorus, acids, and water that contributes to harmful states, including oxidative stress, edema, heart failure, hyperkalemia, hyperphosphatemia, metabolic acidosis, and hyperparathyroidism.

Much research has centered on delaying CKD progression with diet. Still other benefits are possible, according to investigators Norio Hanafusa, MD, Bereket Tessema Lodebo, MD, and Joel D. Kopple, MD, of Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center in Torrance, California. Low protein diets (LPD) with a daily protein intake of 0.6-0.8 g/kg/day and ketoacid or essential amino acid supplemented very low protein diets (SVLPD) might delay dialysis initiation by reducing uremic toxicity. High average protein intakes of 1.03 and 0.99 g protein/kg/day have been reported for male and female patients, respectively, in the United States. Yet a 2007 study by Giuliano Brunori et al. published in the American Journal of Kidney Diseases found that some elderly patients assigned to SVLPDs for 10.7 months safely delayed dialysis initiation. Eventually, 71% of these patients started dialysis due to fluid overload or hyperkalemia.

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