Nutritional intervention strategies provide an alternative, conservative approach to management of chronic kidney disease (CKD)—allowing patients at least the possibility of delaying or avoiding dialysis, according to a comprehensive review published this month in The New England Journal of Medicine.
While questions remain, an analysis of the best available research evidence supports the concept of using a low-protein diet for conservative management of CKD—including a significantly lower risk of progression to end stage renal disease. “A low-protein diet appears to enhance the conservative management of non-dialysis dependent CKD and may be considered as a potential option for CKD patients who wish to avoid or defer dialysis initiation and to slow down the progression of CKD,” said Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the University of California Irvine.
Klahr S, et al.. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med 1994; 330:877−884. [MDRD Study].
Levey AS, et al.. Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. J Am Soc Nephrol 1999; 10:2426–2439.
Haring B, et al.. Dietary protein sources and risk for incident chronic kidney disease: results from the Atherosclerosis Risk in Communities (ARIC) Study. J Ren Nutr 2017; 27:233−242.
Rhee CM, et al.. Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials. J Cachexia Sarcopenia Muscle 2017 Nov 2. doi: 10.1002/jcsm.12264.
Kurella TM, et al.. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 2009; 361:1539–1547.