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Sabatino A, Regolisti G, Gandolfini I, Delsante M, Fani F, Gregorini MC, Fiaccadori E. Diet and enteral nutrition in patients with chronic kidney disease not on dialysis: a review focusing on fat, fiber and protein intake. J Nephrol 2017; 30:743-754. [PMID: 28884267 DOI: 10.1007/s40620-017-0435-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/24/2017] [Indexed: 02/07/2023]
Abstract
The clinical data available on dietary requirements of patients with chronic kidney disease (CKD) not on dialysis are limited and largely inconclusive in terms of the renal, cardiovascular and nutritional outcomes achievable through dietary modifications. Restriction of protein intake during the early stages of CKD may in fact slow its progression, but at the same time this approach may also lead to protein-energy wasting, if energy intake is not adequate and properly monitored. Unfortunately, compliance to dietary recommendations is traditionally low in this patient population. A switch from saturated to mono- and polyunsaturated fats is generally recognized as advantageous for cardiac health; however, the benefits in term of renal function are largely unknown. Similarly, the association between dietary fiber intake and kidney disease is largely unknown. In fact, while there is evidence on the positive health effects of dietary fibers in the general population, nutritional guidelines for CKD lack formal recommendations concerning fiber intake. This paper reviews data and evidence from clinical trials and meta-analyses on renal and cardiovascular outcomes related to modifications in protein, fat and fiber intake. Suggestions for maintaining nutritional status through patient-oriented dietary patterns and enteral supplementation in CKD patients on conservative therapy are also presented.
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Affiliation(s)
- Alice Sabatino
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Giuseppe Regolisti
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Ilaria Gandolfini
- Postgraduate School of Nephrology, University of Parma, Parma, Italy
| | - Marco Delsante
- Postgraduate School of Nephrology, University of Parma, Parma, Italy
| | - Filippo Fani
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy
| | | | - Enrico Fiaccadori
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy. .,Postgraduate School of Nephrology, University of Parma, Parma, Italy.
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Piccoli GB, Capizzi I, Vigotti FN, Leone F, D’Alessandro C, Giuffrida D, Nazha M, Roggero S, Colombi N, Mauro G, Castelluccia N, Cupisti A, Avagnina P. Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines? BMC Nephrol 2016; 17:76. [PMID: 27391228 PMCID: PMC4939031 DOI: 10.1186/s12882-016-0275-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 06/14/2016] [Indexed: 01/11/2023] Open
Abstract
Dietary therapy represents an important tool in the management of chronic kidney disease (CKD), mainly through a balanced reduction of protein intake aimed at giving the remnant nephrons in damaged kidneys a "functional rest". While dialysis, transplantation, and pharmacological therapies are usually seen as "high tech" medicine, non pharmacological interventions, including diets, are frequently considered lifestyle-complementary treatments. Diet is one of the oldest CKD treatments, and it is usually considered a part of "mainstream" management. In this narrative review we discuss how the lessons of complementary alternative medicines (CAMs) can be useful for the implementation and study of low-protein diets in CKD. While high tech medicine is mainly prescriptive, prescribing a "good" life-style change is usually not enough and comprehensive counselling is required; the empathic educational approach, on which CAMs are mainly, though not exclusively based, may support a successful personalized nutritional intervention.There is no gold-standard, low-protein diet for all CKD patients: from among a relatively vast choice, the best compliance is probably obtained by personalization. This approach interferes with the traditional RCT-based analyses which are grounded upon an assumption of equal preference of treatments (ideally blinded). Whole system approaches and narrative medicine, that are widely used in the study of CAMs, may offer ways to integrate EBM and personalised medicine in the search for innovative solutions respecting individualization, but gaining sound data, such as with partially-randomised patient preference trials.
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Affiliation(s)
- Giorgina Barbara Piccoli
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Irene Capizzi
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Federica Neve Vigotti
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Filomena Leone
- />Department of Surgery, SS Dietetics, città della salute e della scienza, University of Torino, Torino, Italy
| | - Claudia D’Alessandro
- />Department of Experimental and Clinical Medicine, SCDU Nephrology, University of Pisa, Pisa, Italy
| | - Domenica Giuffrida
- />Department of Surgery, SS Dietetics, città della salute e della scienza, University of Torino, Torino, Italy
| | - Marta Nazha
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Simona Roggero
- />Department of Clinical and Biological Sciences, SS Nephrology, ASOU san Luigi, University of Torino, Torino, Italy
- />Nephrologie, CH du Mans, Le Mans, France
| | - Nicoletta Colombi
- />Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy
| | - Giuseppe Mauro
- />Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy
| | - Natascia Castelluccia
- />Department of Clinical and Biological Sciences and of Oncology, Library, ASOU san Luigi, University of Torino, Torino, Italy
| | - Adamasco Cupisti
- />Department of Experimental and Clinical Medicine, SCDU Nephrology, University of Pisa, Pisa, Italy
| | - Paolo Avagnina
- />Department of Clinical and Biological Sciences, SSD Clinical Nutrition, ASOU san Luigi, University of Torino, Torino, Italy
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Shide K, Takada Y, Nakashima A, Tsuji H, Wada K, Kuwabara A, Tanaka K, Inagaki N. Patients' perception on the nutritional therapy for diabetic nephropathy. JAPANESE CLINICAL MEDICINE 2014; 5:9-13. [PMID: 24855408 PMCID: PMC4011811 DOI: 10.4137/jcm.s13315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/14/2013] [Accepted: 12/05/2013] [Indexed: 11/30/2022]
Abstract
Low protein diet (LPD) plays an important role in preventing the progression of diabetic nephropathy. However, it is a great burden to the patients. In this paper, we have studied the quality of life (QOL) in such patients. The study subjects were 59 patients (male 38, female 21) with type 2 diabetes. The patients were classified into tertiles based on their protein intake (g/kg BW). Scores from the diet-related QOL questionnaire were summarized by principal component analysis into four components; mental health, less burden, satisfaction and merit, and less social restriction. Higher protein intake was associated with less burden and less social restriction. In multiple regression analysis, the significant predictors for the “less burden” component were higher protein intake/BW and estimated glomerular filtration rate (eGFR). In summary, registered dietitians and clinicians must keep in mind that LPD is a serious burden to the patients and efforts must be made to minimize their burden in order to avoid discontinuation.
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Affiliation(s)
- Kenichiro Shide
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Yuka Takada
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | - Asuka Nakashima
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | - Hidemi Tsuji
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Keiko Wada
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Akiko Kuwabara
- Department of Health and Nutrition, Osaka Shoin Women's University, Osaka, Japan
| | - Kiyoshi Tanaka
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology, and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nutrition prescription to achieve positive outcomes in chronic kidney disease: a systematic review. Nutrients 2014; 6:416-51. [PMID: 24451311 PMCID: PMC3916870 DOI: 10.3390/nu6010416] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/31/2013] [Accepted: 01/07/2014] [Indexed: 11/17/2022] Open
Abstract
In Chronic Kidney Disease (CKD), management of diet is important in prevention of disease progression and symptom management, however evidence on nutrition prescription is limited. Recent international CKD guidelines and literature was reviewed to address the following question “What is the appropriate nutrition prescription to achieve positive outcomes in adult patients with chronic kidney disease?” Databases included in the search were Medline and CINAHL using EBSCOhost search engine, Embase and the Cochrane Database of Systematic Reviews published from 2000 to 2009. International guidelines pertaining to nutrition prescription in CKD were also reviewed from 2000 to 2013. Three hundred and eleven papers and eight guidelines were reviewed by three reviewers. Evidence was graded as per the National Health and Medical Research Council of Australia criteria. The evidence from thirty six papers was tabulated under the following headings: protein, weight loss, enteral support, vitamin D, sodium, fat, fibre, oral nutrition supplements, nutrition counselling, including protein and phosphate, nutrients in peritoneal dialysis solution and intradialytic parenteral nutrition, and was compared to international guidelines. While more evidence based studies are warranted, the customary nutrition prescription remains satisfactory with the exception of Vitamin D and phosphate. In these two areas, additional research is urgently needed given the potential of adverse outcomes for the CKD patient.
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Kim JY, Kim B, Park KS, Choi JY, Seo JJ, Park SH, Kim CD, Kim YL. Health-related quality of life with KDQOL-36 and its association with self-efficacy and treatment satisfaction in Korean dialysis patients. Qual Life Res 2012; 22:753-8. [PMID: 22638994 PMCID: PMC3636437 DOI: 10.1007/s11136-012-0203-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2012] [Indexed: 01/12/2023]
Abstract
Background and objectives This study was conducted to measure the level of health-related quality of life (HRQOL) and to reveal the association of self-efficacy and treatment satisfaction with it in Korean dialysis patients. Design, setting, participants, and measurements The study subjects were 237 patients receiving either hemodialysis (HD) or peritoneal dialysis (PD) from two university hospitals, from February to June in 2010. We investigated HRQOL using the Korean version of Kidney Disease Quality of Life Short Form 36 (KDQOL-36), and self-efficacy and treatment satisfaction by self-administrative questionnaire and their dialysis-related variables by reviewing clinical records. The associations of self-efficacy and treatment satisfaction with HRQOL were assessed using multiple linear regression analysis. Results The mean HRQOL results were as follows: Physical component score (PCS) was 39.1 ± 8.5, Mental component score (MCS) 44.6 ± 6.8, symptom/problem list was 67.6 ± 17.1, effects of disease score was 58.5 ± 19.6, and burden of disease score was 41.1 ± 28.4. Between PD and HD patients, we could find significant difference only in the symptom/problem list. After removing confounder’s effects by multivariate analysis, respectively, treatment goal self-efficacy and treatment management self-efficacy were significantly related with all 5 domains, except PCS. Treatment satisfaction was significantly related with PCS, MCS, and effects of kidney disease. Conclusions Patients’ self-efficacy and treatment satisfaction could influence their HRQOL. Regular and systematic monitoring using KDQOL-36 and interventions to increase self-efficacy and treatment satisfaction should be considered in dialysis care in Korea.
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Affiliation(s)
- Jong-Yeon Kim
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Bokyoung Kim
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, 816-15 Jinjudaero, Jinju city, Gyeongnam Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, 816-15 Jinjudaero, Jinju city, Gyeongnam Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Ji-Young Choi
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Jung-Ju Seo
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
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Khalil AA, Frazier SK. Depressive symptoms and dietary nonadherence in patients with end-stage renal disease receiving hemodialysis: a review of quantitative evidence. Issues Ment Health Nurs 2010; 31:324-30. [PMID: 20394478 DOI: 10.3109/01612840903384008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with end-stage renal disease (ESRD) who receive hemodialysis have high rates of psychosocial distress and nonadherence to diet prescription. The purpose of this study was to examine the quantitative research evidence about the effect of depressive symptoms on dietary adherence. A systematic search of the literature using MEDLINE, CINAHL, PubMed, and PsycINFO databases was performed for quantitative research studies. Forty-four studies met inclusion criteria and were included in this review. Nearly all studies supported an association between depressive symptoms and dietary adherence in patients with ESRD. Depressive symptoms were associated with dietary nonadherence in patients with ESRD.
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Kudielka BM, Hawkley LC, Adam EK, Cacioppo JT. Compliance with ambulatory saliva sampling in the Chicago Health, Aging, and Social Relations Study and associations with social support. Ann Behav Med 2007; 34:209-16. [DOI: 10.1007/bf02872675] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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