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2016 ; 48
(5
): 725-9
Nephropedia Template TP
gab.com Text
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Back to the future: restricted protein intake for conservative management of CKD,
triple goals of renoprotection, uremia mitigation, and nutritional health
#MMPMID26886110
Kovesdy CP
; Kalantar-Zadeh K
Int Urol Nephrol
2016[May]; 48
(5
): 725-9
PMID26886110
show ga
Lowering dietary protein intake (DPI) to approximately 0.6-0.8 g/kgBW/day may be
renoprotective through various mechanisms, and it has been recommended in
patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) as a means
to also control various metabolic consequences of advanced CKD, such as uremic
symptoms, hyperparathyroidism, hypertension, hyperkalemia, and hyperphosphatemia.
A meta-analysis in this issue of the Journal suggests that low-protein diet is
effective and safe when used to retard progression of CKD and alleviate uremic
complications. A potential deleterious consequence of lowering DPI in this
population is the development or worsening of protein-energy wasting (PEW), which
can contribute to poor clinical outcomes such as higher mortality and morbidity.
There is currently insufficient high-level evidence to determine the ideal level
of DPI in patients with NDD-CKD with high risk of PEW. For the time being we
recommend a DPI of 0.6-0.8 g/kgBW/day, and increasing this as needed on an
individual basis in patients with PEW. Further examination of this dilemma in
randomized controlled clinical trials will be necessary.
|*Diet, Protein-Restricted/adverse effects
[MESH]
|Conservative Treatment/methods
[MESH]
|Goals
[MESH]
|Humans
[MESH]
|Nutritional Requirements
[MESH]
|Nutritional Status
[MESH]
|Protein-Energy Malnutrition/*etiology/prevention & control
[MESH]