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BMC Nephrology
Published in: BMC Nephrology 1/2016

Open Access 01-12-2016 | Review

Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?

Authors: Giorgina Barbara Piccoli, Irene Capizzi, Federica Neve Vigotti, Filomena Leone, Claudia D’Alessandro, Domenica Giuffrida, Marta Nazha, Simona Roggero, Nicoletta Colombi, Giuseppe Mauro, Natascia Castelluccia, Adamasco Cupisti, Paolo Avagnina

Published in: BMC Nephrology | Issue 1/2016

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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.
Literature
1.
2.
Sinnakirouchenan R, Holley JL. Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues. Adv Chronic Kidney Dis. 2011;18:428–32.PubMedCrossRef
3.
Remuzzi G, Benigni A, Finkelstein FO, et al. Kidney failure: aims for the next 10 years and barriers to success. Lancet. 2013;3(82):353–62.CrossRef
4.
Zoorob R, Chakrabarty S, O’Hara H, Kihlberg C. Which CAM modalities are worth considering? J Fam Pract. 2014;63:585–90.PubMedPubMedCentral
5.
Snyder J, Brown P. Complementary and alternative medicine in children: an analysis of the recent literature. Curr Opin Pediatr. 2012;24:539–46.PubMedCrossRef
6.
Huebner J, Marienfeld S, Abbenhardt C, et al. Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice. Anticancer Res. 2014;34:39–48.PubMed
7.
Zander ME, Wargovich MJ, Hebert JR. Methodologic considerations in the study of diet as part of complementary and alternative medicine modalities. Altern Ther Health Med. 2004;10:56–61.PubMed
8.
9.
10.
Addis T. Glomerular nephritis: Diagnosis and treatment. London, UK: Macmillan; 1949.
11.
Piccoli GB. Patient-based continuum of care in nephrology: why read Thomas Addis’ “Glomerular Nephritis” in 2010? J Nephrol. 2010;23:164–7.PubMed
12.
Borst JG. Protein katabolism in uraemia; effects of protein-free diet, infections, and blood-transfusions. Lancet. 1948;1:824–9.PubMedCrossRef
13.
Giovannetti S, Maggiore Q. A low-nitrogen diet with proteins of high biological value for severe chronic uraemia. Lancet. 1964;1:1000–3.PubMedCrossRef
14.
15.
16.
Wright PL, Brereton PJ, Snell DEM. Effectiveness of modified Giovannetti diet compared with mixed low-protein diet. Metabolism. 1970;19:201–13.PubMedCrossRef
17.
Hood CEA, Beale DJ, Housley J, Hardwicke J. Dialysed egg as nitrogen source in dietray control of chronic renal failure. Lancet. 1969;293:479–82.CrossRef
18.
Franklin SS, Gordon A, Kleeman CR, Maxwell MH. Use of a balanced low-protein diet in chronic renal failure. JAMA. 1967;202:477–84.PubMedCrossRef
19.
Berlyne GM, Gaan D, Ginks WR. Dietary treatment of chronic renal failure. Am J Clin Nutr. 1968;21:547–52.PubMed
20.
Mitch WE, Remuzzi G. Diets for patients with chronic kidney disease, still worth prescribing. J Am Soc Nephrol. 2004;15:234–7.PubMedCrossRef
21.
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Wang AY, Yang CW. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382:260–72.PubMedCrossRef
22.
Bergstrom J. Discovery and rediscovery of low protein diet. Clin Nephrol. 1984;21:29–35.PubMed
23.
Walser M, Mitch WE, Maroni BJ, Kopple JD. Should protein intake be restricted in predialysis patients? Kidney Int. 1999;55:771–7.PubMedCrossRef
24.
Piccoli GB, Ferraresi M, Deagostini MC, et al. Vegetarian low-protein diets supplemented with keto analogues: a niche for the few or an option for many? Nephrol Dial Transplant. 2013;28:2295–305.PubMedCrossRef
25.
Foundation NK. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1–266.
26.
Eckardt KU, Berns JS, Rocco MV, Kasiske BL. Definition and classification of CKD: the debate should be about patient prognosis--a position statement from KDOQI and KDIGO. Am J Kidney Dis. 2009;53:915–20.PubMedCrossRef
27.
López-Novoa JM, Rodríguez-Peña AB, Ortiz A, Martínez-Salgado C, López Hernández FJ. Etiopathology of chronic tubular, glomerular and renovascular nephropathies: clinical implications. J Transl Med. 2011;9:13–30.PubMedPubMedCentralCrossRef
28.
Burns A, Carson R. Maximum conservative management: a worthwhile treatment for elderly patients with renal failure who choose not to undergo dialysis. J Palliat Med. 2007;10:1245–7.PubMedCrossRef
29.
Murtagh FE, Sheerin NS, Addington-Hall J, Higginson IJ. Trajectories of illness in stage 5 chronic kidney disease: a longitudinal study of patient symptoms and concerns in the last year of life. Clin J Am Soc Nephrol. 2011;6:1580–90.PubMedCrossRef
30.
O’Hare AM, Batten A, Burrows NR, et al. Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis. Am J Kidney Dis. 2012;59:513–22.PubMedPubMedCentralCrossRef
31.
Peralta CA, Vittinghoff E, Bansal N, et al. Trajectories of kidney function decline in young black and white adults with preserved GFR: results from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Kidney Dis. 2013;62:261–6.PubMedPubMedCentralCrossRef
32.
Li L, Chang A, Rostand SG, et al. A within-patient analysis for time-varying risk factors of CKD progression. J Am Soc Nephrol. 2014;25:606–13.PubMedCrossRef
33.
34.
Levey AS, Inker LA, Matsushita K, et al. GFR decline as an end point for clinical trials in CKD: a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration. Am J Kidney Dis. 2014;64:821–35.PubMedCrossRef
35.
Lambers Heerspink HJ, Tighiouart H, et al. GFR decline and subsequent risk of established kidney outcomes: a meta-analysis of 37 randomized controlled trials. Am J Kidney Dis. 2014;64:860–6.PubMedCrossRef
36.
Greene T, Teng CC, Inker LA, et al. Utility and validity of estimated GFR-based surrogate time-to-event end points in CKD: a simulation study. Am J Kidney Dis. 2014;64:867–79.PubMedCrossRef
37.
Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol. 1981;241:F85–93.PubMed
38.
Brenner BM. Nephron adaptation to renal injury or ablation. Am J Physiol. 1985;249(3 Pt 2):F324–37.PubMed
39.
Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994;330:877–84.PubMedCrossRef
40.
Levey AS, Greene T, Beck GJ, Caggiula AW, Kusek JW, Hunsicker LG, Klahr S. Dietary protein restriction and the progression of chronic renal disease: What have all of the results of the MDRD study shown? J Am Soc Nephrol. 1999;10:2426–39.PubMed
41.
Kopple JD, Greene T, Chumlea WC, et al. Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study. Kidney Int. 2000;57:1688–703.PubMedCrossRef
42.
Viberti G, Bognetti E, Wiseman MJ, Dodds R, Gross JL, Keen H. Effect of protein-restricted diet on renal response to a meat meal in humans. Am J Physiol. 1987;253(3 Pt 2):F388–93.PubMed
43.
Bernhard J, Beaufrere B, Laville M, Fouque D. Adaptive response to a low-protein diet in predialysis chronic renal failure patients. J Am Soc Nephrol. 2001;12(6):1249–54.PubMed
44.
Nesrallah GE, Mustafa RA, Clark WF, et al. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ. 2014;186(2):112–7.PubMedPubMedCentralCrossRef
45.
el Nahas AM, Coles GA. Dietary treatment of chronic renal failure: ten unanswered questions. Lancet. 1986;1:597–600.PubMedCrossRef
46.
Fouque D, Laville M. Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev. 2009;(3).
47.
Fouque D, Mitch WE. Low-protein diets in chronic kidney disease: are we finally reaching a consensus? Nephrol Dial Transplant. 2015;30:6–8.PubMedCrossRef
48.
Mennini F, Russo S, Marcellusi A, Quintaliani G, Fouque D. Economic effects of treatment of chronic kidney disease with low-protein diet. J Ren Nutr. 2014;24:313–21.PubMedCrossRef
49.
Scalone L, Borghetti F, Brunori G, et al. Cost-benefit analysis of supplemented very low-protein diet versus dialysis in elderly CKD5 patients. Nephrol Dial Transplant. 2010;25:907–13.PubMedCrossRef
50.
Giovannetti S. Dietary treatment of chronic renal failure: why is it not used more frequently? Nephron. 1985;40:1–12.PubMedCrossRef
51.
Piccoli GB, Deagostini MC, Vigotti FN, et al. Which low-protein diet for which CKD patient? An observational, personalized approach. Nutrition. 2014;30:992–9.PubMedCrossRef
52.
Maiorca R, Brunori G, Viola BF, Zubani R, Cancarini G, Parrinello G, De Carli A. Diet or dialysis in the elderly? The DODE study: a prospective randomized multicenter trial. J Nephrol. 2000;13:267–70.PubMed
53.
Brunori G, Viola BF, Parrinello G, et al. Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am J Kidney Dis. 2007;49:569–80.PubMedCrossRef
54.
Garneata L, Mircescu G. Effect of low-protein diet supplemented with keto acids on progression of chronic kidney disease. J Ren Nutr. 2013;23:210–3.PubMedCrossRef
55.
Teplan V. Effect of keto acids on asymmetric dimethylarginine, muscle, and fat tissue in chronic kidney disease and after kidney transplantation. J Ren Nutr. 2009;19(5 Suppl):S27–9.PubMedCrossRef
56.
Teplan V, Schück O, Knotek A, Hajný J, Horácková M, Skibová J. Malý J Effects of low-protein diet supplemented with ketoacids and erythropoietin in chronic renal failure: a long-term metabolic study. Ann Transplant. 2001;6:47–53.PubMed
57.
Cianciaruso B, Pota A, Pisani A, et al. Metabolic effects of two low protein diets in chronic kidney disease stage 4-5--a randomized controlled trial. Nephrol Dial Transplant. 2008;23:636–44.PubMedCrossRef
58.
Bellizzi V, Chiodini P, Cupisti A, et al. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrol Dial Transplant. 2015;30:71–7.PubMedCrossRef
59.
Garneata L, Stancu A, Dragomir D, Stefan G, Mircescu G. Ketoanalogue-Supplemented Vegetarian Very Low-Protein Diet and CKD Progression. J Am Soc Nephrol. 2016. [Epub ahead of print].
60.
Giovannetti S, on behalf of the Steering Committee of the European Study Groups for the conservative treatment of chronic renal failure. Answers to ten questions on the dietary treatment of chronic renal failure. Lancet. 1986;328:1140–2.CrossRef
61.
Fouque D, Aparicio M. Eleven reasons to control the protein intake of patients with chronic kidney disease. Nat Clin Pract Nephrol. 2007;3:383–92.PubMedCrossRef
62.
Aparicio M, Chauveau P, Combe C. Low protein diets and outcome of renal patients. J Nephrol. 2001;14(6):433–9.PubMed
63.
Chen LI, Guh JY, Wu KD, Chen YM, Kuo MC, Hwang SJ, Chen TH, Chen HC. Modification of diet in renal disease (MDRD) study and CKD epidemiology collaboration (CKD-EPI) equations for Taiwanese adults. PLoS One. 2014;9:e99645.PubMedPubMedCentralCrossRef
64.
McCullough ML, Feskanich D, Stampfer MJ, et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002;76:1261–71.PubMed
65.
Johnson DW. Dietary protein restriction as a treatment for slowing chronic kidney disease progression: the case against. Nephrology (Carlton). 2006;11:58–62.CrossRef
66.
Maroni BJ. Protein restriction and malnutrition in renal disease: fact or fiction? Miner Electrolyte Metab. 1997;23:225–8.PubMed
67.
Combe C, Deforges-Lasseur C, Caix J, Pommereau A, Marot D, Aparicio M. Compliance and effects of nutritional treatment on progression and metabolic disorders of chronic renal failure. Nephrol Dial Transplant. 1993;8:412–8.PubMed
68.
Maroni BJ. Protein restriction in the pre-end-stage renal disease (ESRD) patient: who, when, how, and the effect on subsequent ESRD outcome. J Am Soc Nephrol. 1998;9(12 Suppl):S100–6.PubMed
69.
Piccoli GB. The never-ending search for the perfect dialysis. Should we move from the best treatment to the best system? Nephrol Dial Transplant. 2011;26:1128–31.PubMedCrossRef
70.
71.
Twardowski ZJ, Misra M. “Daily” Dialysis—Lessons from a randomized, controlled trial. N Engl J Med. 2010;363:2363–4.PubMedCrossRef
72.
Milas NC, Nowalk MP, Akpele L, et al. Factors associated with adherence to the dietary protein intervention in the Modification of Diet in Renal Disease Study. J Am Diet Assoc. 1995;95:1295–300.PubMedCrossRef
73.
Coyne T, Olson M, Bradham K, Garcon M, Gregory P, Scherch L. Dietary satisfaction correlated with adherence in the Modification of Diet in Renal Disease Study. J Am Diet Assoc. 1995;95:1301–6.PubMedCrossRef
74.
Ciarambino T, Castellino P, Paolisso G, et al. Long term effects of low protein diet on depressive symptoms and quality of life in elderly Type 2 diabetic patients. Clin Nephrol. 2012;78:122–8.PubMedCrossRef
75.
Sánchez C, Aranda P, Planells E, et al. Influence of low-protein dietetic foods consumption on quality of life and levels of B vitamins and homocysteine in patients with chronic renal failure. Nutr Hosp. 2010;25:238–44.PubMed
76.
Kanazawa Y, Nakao T, Ohya Y, Shimomitsu T. Association of socio-psychological factors with the effects of low protein diet for the prevention of the progression of chronic renal failure. Intern Med. 2006;45:199–206.PubMedCrossRef
77.
Piccoli GB, Vigotti FN, Leone F, et al. Low-protein diets in CKD: how can we achieve them? A narrative, pragmatic review. Clin Kidney J. 2015;8:61–70.PubMedCrossRef
78.
Bellizzi V. Low-protein diet or nutritional therapy in chronic kidney disease? Blood Purif. 2013;36:41–6.PubMedCrossRef
79.
Chauveau P, Aparicio M. Benefits in nutritional interventions in patients with CKD stage 3–4. J Ren Nutr. 2011;21:20–2.PubMedCrossRef
80.
Montemurno E, Cosola C, Dalfino G, et al. What would you like to eat, Mr CKD Microbiota? A Mediterranean Diet, please! Kidney Blood Press Res. 2014;39:114–23.PubMedCrossRef
81.
Millward DJ, Jackson AA. Protein/energy ratios of current diets in developed and developing countries compared with a safe protein/energy ratio: implications for recommended protein and amino acid intakes. Public Health Nutr. 2004;7:387–405.PubMedCrossRef
82.
Volpi E, Campbell WW, Dwyer JT, et al. Is the optimal level of protein intake for older adults greater than the recommended dietary allowance? J Gerontol A Biol Sci Med Sci. 2013;68:677–81.PubMedCrossRef
83.
Keys A, Aravanis C, Buchem FSP, Blackburn H. The diet and all-causes death rate in the Seven Countries Study. Lancet. 1981;2:58–61.
84.
Trichopoulou A, Lagiou P. Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutr Rev. 1997;55:383–9.PubMedCrossRef
85.
Estruch R, Ros E, Salas-Salvadó J, et al. PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90.PubMedCrossRef
86.
Trichopoulou A, Martínez-González MA, Tong TY, et al. Definitions and potential health benefits of the Mediterranean diet: views from experts around the world. BMC Med. 2014;12:112.PubMedPubMedCentralCrossRef
87.
Larsson SC, Orsini N. Red meat and processed meat consumption and all-cause mortality: a meta-analysis. Am J Epidemiol. 2014;179:282–9.PubMedCrossRef
88.
Jacobson MF, Havas S, McCarter R. Changes in sodium levels in processed and restaurant foods, 2005 to 2011. JAMA Intern Med. 2013;173:1285–91.PubMedCrossRef
89.
Sylvetsky AC, Dietz WH. Nutrient-content claims--guidance or cause for confusion? N Engl J Med. 2014;371:195–8.PubMedCrossRef
90.
World Health Organization. Evaluation of certain food additives. World Health Organ Tech Rep Ser. 2012;974:1–183.
91.
Watson D. Vegan News, No. 1, November 1944.
92.
93.
94.
Gilsing AM, Weijenberg MP, Goldbohm RA, Dagnelie PC, van den Brandt PA, Schouten LJ. The Netherlands Cohort Study − Meat Investigation Cohort; a population-based cohort over-represented with vegetarians, pescetarians and low meat consumers. Nutr J. 2013;12:156.PubMedPubMedCentralCrossRef
95.
96.
Barsotti G, Morelli E, Cupisti A, Meola M, Dani L, Giovannetti S. A low-nitrogen low-phosphorus Vegan diet for patients with chronic renal failure. Nephron. 1996;74:390–4.PubMedCrossRef
97.
Anderson JW, Blake JE, Turner J, Smith BM. Effects of soy protein on renal function and proteinuria in patients with type 2 diabetes. Am J Clin Nutr. 1998;68(6 Suppl):1347S–53.PubMed
98.
99.
Cupisti A, Ghiadoni L, D’Alessandro C, et al. Soy protein diet improves endothelial dysfunction in renal transplant patients. Nephrol Dial Transplant. 2007;22:229–34.PubMedCrossRef
100.
Moe SM, Zidehsarai MP, Chambers MA, et al. Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol. 2011;6:257–64.PubMedPubMedCentralCrossRef
101.
Soroka N, Silverberg DS, Greemland M, Birk Y, Blum M, Peer G, Iaina A. Comparison of a vegetable-based (soya) and an animal-based low-protein diet in predialysis chronic renal failure patients. Nephron. 1998;79:173–80.PubMedCrossRef
102.
Buzio C, Mutti A, Perazzoli F, Alinovi R, Arisi L, Negro A. Protein-induced changes in kidney function depend on the time of administration but not on the dietary source. Nephron. 1990;56:234–40.PubMedCrossRef
103.
King AJ, Levey AS. Dietary protein and renal function. J Am Soc Nephrol. 1993;3:1723–37.PubMed
104.
Chauveau P, Combe C, Fouque D, Aparicio M. Vegetarianism: advantages and drawbacks in patients with chronic kidney diseases. J Ren Nutr. 2013;23:399–405.PubMedCrossRef
105.
Zhang J, Liu J, Su J, Tian F. The effects of soy protein on chronic kidney disease: a meta-analysis of randomized controlled trials. Eur J Clin Nutr. 2014;68:987–93.PubMedCrossRef
106.
Causso C, Arrieta F, Hernández J, et al. Severe ketoacidosis secondary to starvation in a frutarian patient. Nutr Hosp. 2010;25:1049–52.PubMed
107.
Sitprija V, Suvanpha R. Low protein diet and chronic renal failure in Buddhist monks. Br Med J (Clin Res Ed). 1983;287(6390):469–71.CrossRef
108.
Krucoff MW, Crater SW, Gallup D, et al. Music, imagery, touch, and prayer as adjuncts to interventional cardiac care: the Monitoring and Actualisation of Noetic Trainings (MANTRA) II randomised study. Lancet. 2005;366(9481):211–7.PubMedCrossRef
109.
Black DS, Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci. 2016. doi:10.​1111/​nyas.​12998 [Epub ahead of print].PubMed
110.
Craig WJ, Mangels AR, Association AD. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009;109:1266–82.PubMedCrossRef
111.
American Dietetic Association; Dietitians of Canada. Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets. Can J Diet Pract Res. 2003;64:62–81.CrossRef
112.
Craig WJ. Nutrition concerns and health effects of vegetarian diets. Nutr Clin Pract. 2010;25:613–20.PubMedCrossRef
113.
Piccoli GB, Clari R, Vigotti FN, et al. Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review. BJOG. 2015;122:623–33.PubMedCrossRef
114.
Walser M, Mitch WE, Abras E. Supplements containing amino acids and keto acids in the treatment of chronic uremia. Kidney Int Suppl. 1983;16:S285–9.PubMed
115.
Aparicio M, Bellizzi V, Chauveau P, et al. Keto acid therapy in predialysis chronic kidney disease patients: final consensus. J Ren Nutr. 2012;22(2 Suppl):S22–4.PubMedCrossRef
116.
Liou HH. What can a keto acid/amino acid-supplemented protein-restricted diet do for the “butterfly effect” in chronic kidney disease patients? J Ren Nutr. 2009;19(5 Suppl):S15–8.PubMedCrossRef
117.
Shah AP, Kalantar-Zadeh K, Kopple JD. Is There a Role for Ketoacid Supplements in the Management of CKD? Am J Kidney Dis. 2015.
118.
Piccoli GB, Attini R, Vasario E, et al. Vegetarian supplemented low-protein diets. A safe option for pregnant CKD patients: report of 12 pregnancies in 11 patients. Nephrol Dial Transplant. 2011;26:196–205.PubMedCrossRef
119.
Piccoli GB, Leone F, Attini R, et al. Association of low-protein supplemented diets with fetal growth in pregnant women with CKD. Clin J Am Soc Nephrol. 2014;9:864–73.PubMedPubMedCentralCrossRef
120.
Piccoli GB, Motta D, Martina G, et al. Low-protein vegetarian diet with alpha-chetoanalogues prior to pre-emptive pancreas-kidney transplantation. Rev Diabet Stud. 2004;1:95–102.PubMedPubMedCentralCrossRef
121.
Piccoli GB, Guzzo G, Vigotti FN, et al. Tailoring dialysis and resuming low-protein diets may favor chronic dialysis discontinuation: Report on three cases. Hemodial Int. 2014;18(3):590–5.PubMedCrossRef
122.
Schefold JC, Zeden JP, Fotopoulou C, et al. Increased indoleamine 2, 3-dioxygenase (IDO) activity and elevated serum levels of tryptophan catabolites in patients with chronic kidney disease: a possible link between chronic inflammation and uraemic symptoms. Nephrol Dial Transplant. 2009;24:1901–8.PubMedCrossRef
123.
Sallée M, Dou L, Cerini C, Poitevin S, Brunet P, Burtey S. The aryl hydrocarbon receptor-activating effect of uremic toxins from tryptophan metabolism: a new concept to understand cardiovascular complications of chronic kidney disease. Toxins (Basel). 2014;6:934–49.CrossRef
124.
Aparicio M, Cano NJ, Cupisti A, et al. Keto-acid therapy in predialysis chronic kidney disease patients: consensus statements. J Ren Nutr. 2009;19(5 Suppl):S33–5.PubMedCrossRef
125.
Willcox DC, Willcox BJ, Todoriki H, Suzuki M. The Okinawan diet: health implications of a low-calorie, nutrient-dense, antioxidant-rich dietary pattern low in glycemic load. J Am Coll Nutr. 2009;28(Suppl):500S–16.PubMedCrossRef
126.
Miyagi S, Iwama N, Kawabata T, Hasegawa K. Longevity and diet in Okinawa, Japan: the past, present and future. Asia Pac J Public Health. 2003;15(Suppl):S3–9.PubMedCrossRef
127.
Gavrilova NS, Gavrilov LA. Comments on dietary restriction, Okinawa diet and longevity. Gerontology. 2012;58:221–3. discussion 224–6.PubMedCrossRef
128.
Willcox BJ, Willcox DC, Todoriki H, et al. Caloric restriction, the traditional Okinawan diet, and healthy aging: the diet of the world’s longest-lived people and its potential impact on morbidity and life span. Ann N Y Acad Sci. 2007;1114:434–55.PubMedCrossRef
129.
Sotos-Prieto M, Moreno-Franco B, Ordovás JM, León M, Casasnovas JA, Peñalvo JL. Design and development of an instrument to measure overall lifestyle habits for epidemiological research: the Mediterranean Lifestyle (MEDLIFE) index. Public Health Nutr. 2015;18:959–67.PubMedCrossRef
130.
Fujita R, Braun KL, Hughes CK. The traditional Hawaiian diet: a review of the literature. Pac Health Dialog. 2004;11:250–9.PubMed
131.
McKerchar C, Bowers S, Heta C, Signal L, Matoe L. Enhancing Māori food security using traditional kai. Glob Health Promot. 2014 Aug 1. pii: 1757975914543573. [Epub ahead of print].
132.
Laird BD, Goncharov AB, Egeland GM, Chan HM. Dietary advice on Inuit traditional food use needs to balance benefits and risks of mercury, selenium, and n3 fatty acids. J Nutr. 2013;143:923–30.PubMedCrossRef
133.
Li JR, Hsieh YH. Traditional Chinese food technology and cuisine. Asia Pac J Clin Nutr. 2004;13:147–55.PubMed
134.
Chen C. Eating patterns-- a prognosis for China. Asia Pac J Clin Nutr. 1995;4 Suppl 1:24–8.PubMed
135.
Mahadevan M, Blair D, Raines ER. Changing food habits in a South Indian Hindu Brahmin community: a case of transitioning gender roles and family dynamics. Ecol Food Nutr. 2014;53:596–617.PubMedCrossRef
136.
Ethan D, Basch CH, Rajan S, Samuel L, Hammond RN. A comparison of the nutritional quality of food products advertised in grocery store circulars of high-versus low-income New York City zip codes. Int J Environ Res Public Health. 2013;11:537–47.PubMedPubMedCentralCrossRef
137.
D’Alessandro C, Rossi A, Innocenti M, et al. Dietary protein restriction for renal patients: don’t forget protein-free foods. J Ren Nutr. 2013;23:367–71.PubMedCrossRef
138.
Giovannetti S. Low protein diet in chronic uremia: a historical survey. Contrib Nephrol. 1986;53:1–6.PubMedCrossRef
139.
Van Duyn MA. Acceptability of selected low-protein products for use in a potential diet therapy for chronic renal failure. J Am Diet Assoc. 1987;87:909–14.PubMed
140.
Giordano M, Ciarambino T, Castellino P, Paolisso G. Light and shadows of dietary protein restriction in elderly with chronic kidney disease. Nutrition. 2013;29:1090–3.PubMedCrossRef
141.
Thilly N. Low-protein diet in chronic kidney disease: from questions of effectiveness to those of feasibility. Nephrol Dial Transplant. 2013;28:2203–5.PubMedCrossRef
142.
Cianciaruso B, Capuano A, D’Amaro E, et al. Dietary compliance to a low protein and phosphate diet in patients with chronic renal failure. Kidney Int Suppl. 1989;27:S173–6.PubMed
143.
Giordano M, Ciarambino T, Castellino P, et al. Long-term effects of moderate protein diet on renal function and low-grade inflammation in older adults with type 2 diabetes and chronic kidney disease. Nutrition. 2014;30:1045–9.PubMedCrossRef
144.
Cupisti A, Morelli E, Meola M, Barsotti M, Barsotti G. Vegetarian diet alternated with conventional low-protein diet for patients with chronic renal failure. J Ren Nutr. 2002;12:32–7.PubMedCrossRef
145.
146.
147.
Segen’s Medical Dictionary. © 2012 Farlex, Inc.
148.
The McGraw-Hill Dictionary of Scientific and Technical Terms. Seventh Edition: Mc Graw-Hill, New York;2012.
149.
150.
151.
Moorthi RN, Armstrong CL, Janda K, Ponsler-Sipes K, Asplin JR, Moe SM. The effect of a diet containing 70 % protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease. Am J Nephrol. 2014;40:582–91.PubMedCrossRef
152.
Jones L, Moschonis G, Oliveira A, et al. The influence of early feeding practices on healthy diet variety score among pre-school children in four European birth cohorts. Public Health Nutr. 2014;20:1–11.
153.
Di Daniele N, Di Renzo L, Noce A, et al. Effects of Italian Mediterranean organic diet vs. low-protein diet in nephropathic patients according to MTHFR genotypes. J Nephrol. 2014;27:529–36.PubMedCrossRef
154.
Kovesdy CP. Traditional and novel dietary interventions for preventing progression of chronic kidney disease. J Ren Nutr. 2013;23:241–5.PubMedCrossRef
155.
Willingham F. The dietary management of patients with diabetes and renal disease: challenges and practicalities. J Ren Care. 2012;38 Suppl 1:40–51.PubMedCrossRef
156.
Ikizler TA. Protein and energy intake in advanced chronic kidney disease: how much is too much? Semin Dial. 2007;20:5–11.PubMedCrossRef
157.
Walser M, Hill S. Can renal replacement be deferred by a supplemented very low protein diet? J Am Soc Nephrol. 1999;10:110–6.PubMed
158.
Sidorenkov G, Navis G. Safety of ACE inhibitor therapies in patients with chronic kidney disease. Expert Opin Drug Saf. 2014;13:1383–95.PubMedCrossRef
159.
Mitch WE. Beneficial responses to modified diets in treating patients with chronic kidney disease. Kidney Int Suppl. 2005;94:S133–5.PubMedCrossRef
160.
Friedman AN. New evidence for an old strategy to help delay the need for dialysis. Am J Kidney Dis. 2007;49:563–5.PubMedCrossRef
161.
De las Cuevas C. Towards a clarification of terminology in medicine taking behavior: compliance, adherence and concordance are related although different terms with different uses. Curr Clin Pharmacol. 2011;6:74–7.PubMedCrossRef
162.
Khair K. Compliance, concordance and adherence: what are we talking about? Haemophilia. 2014;20:601–3.PubMedCrossRef
163.
164.
Patwardhan B, Ayurveda GCP. Guidelines: Need for freedom from RCT ascendancy in favor of whole system approach. J Ayurveda Integr Med. 2011;22:1–4.CrossRef
165.
166.
Kitsios GD, Kent DM. Personalised medicine: not just in our genes. BMJ 2012;e2161
167.
168.
169.
170.
Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med. 2000;342:1878–86.PubMedCrossRef
171.
Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342:1887–92.PubMedPubMedCentralCrossRef
172.
173.
Verhoef MJ, Lewith G, Ritenbaugh C, Boon H, Fleishman S, Leis A. Complementary and alternative medicine whole systems research: beyond identification of inadequacies of the RCT. Complement Ther Med. 2005;13:206–12.PubMedCrossRef
174.
Verhoef MJ, Casebeer AL, Hilsden RJ. Assessing efficacy of complementary medicine: adding qualitative research methods to the “Gold Standard”. J Altern Complement Med. 2002;8:275–81.PubMedCrossRef
175.
Ritenbaugh C, Verhoef M, Fleishman S, Boon H, Leis A. Whole systems research: a discipline for studying complementary and alternative medicine. Altern Ther Health Med. 2003;9:32–6.PubMed
176.
177.
King M, Nazareth I, Lampe F, et al. Conceptual framework and systematic review of the effects of participants’ and professionals’ preferences in randomised controlled trials. Health Technol Assess. 2005;9:1–186. iii-iv.PubMedCrossRef
178.
Cao HJ, Liu JP, Hu H, Wang NS. Using a partially randomized patient preference study design to evaluate the therapeutic effect of acupuncture and cupping therapy for fibromyalgia: study protocol for a partially randomized controlled trial. Trials. 2014;15:280.PubMedPubMedCentralCrossRef
179.
Hubacher D, Spector H, Monteith C, Chen PL, Hart C. Rationale and enrollment results for a partially randomized patient preference trial to compare continuation rates of short-acting and long-acting reversible contraception. Contraception. 2015;91:185–92.PubMedCrossRef
180.
Leiva-Fernández F, Leiva-Fernández J, Zubeldia-Santoyo F, García-Ruiz A, Prados-Torres D, Barnestein-Fonseca P. Efficacy of two educational interventions about inhalation techniques in patients with chronic obstructive pulmonary disease (COPD). TECEPOC: study protocol for a partially randomized controlled trial (preference trial). Trials. 2012;13:64.PubMedPubMedCentralCrossRef
181.
Klein S, Cumming GP, Lee AJ, Alexander DA, Bolsover D. Evaluating the effectiveness of a web-based intervention to promote mental wellbeing in women and partners following miscarriage, using a modified patient preference trial design: an external pilot. BJOG. 2012;119:762–7.PubMedCrossRef
182.
Halpern SD. Evaluating preference effects in partially unblinded, randomized clinical trials. J Clin Epidemiol. 2003;56:109–15.PubMedCrossRef
183.
Mu W, Shang H. Understanding patient values and the manifestations in clinical research with traditional chinese medicine-with practical suggestions for trial design and implementation. Evid Based Complement Alternat Med. 2013;2013:847273.PubMedPubMedCentralCrossRef
184.
Borradaile KE, Halpern SD, Wyatt HR, et al. Relationship between treatment preference and weight loss in the context of a randomized controlled trial. Obesity (Silver Spring). 2012;20:1218–22.CrossRef
185.
Preference Collaborative Review Group. Patients’ preferences within randomised trials: systematic review and patient level meta-analysis. BMJ. 2008;337:a1864.PubMedCentralCrossRef
186.
Gemmell I, Dunn G. The statistical pitfalls of the partially randomized preference design in non-blinded trials of psychological interventions. Int J Methods Psychiatr Res. 2011;20:1–9.PubMedCrossRef
187.
Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286:1897–902.PubMedCrossRef
188.
189.
190.
Meisel ZF, Karlawish J. Narrative vs evidence-based medicine--and, not or. JAMA. 2011;306:2022–3.PubMedCrossRef
191.
Spiegel DM, Brady K. Calcium balance in normal individuals and in patients with chronic kidney disease on low-and high-calcium diets. Kidney Int. 2012;81(11):1116–22.PubMedPubMedCentralCrossRef
192.
Filipowicz R, Beddhu S. Optimal nutrition for predialysis chronic kidney disease. Adv Chronic Kidney Dis. 2013;20(2):175–80.PubMedCrossRef
193.
Cupisti A, Kalantar-Zadeh K. Management of natural and added dietary phosphorus burden in kidney disease. Semin Nephrol. 2013;33:180–90.PubMedCrossRef
194.
Sarathy S, Sullivan C, Leon JB, Sehgal AR. Fast food, phosphorus-containing additives, and the renal diet. J Ren Nutr. 2008;18:466–70.PubMedCrossRef
195.
D’Alessandro C, Piccoli GB, Cupisti A. The “phosphorus pyramid”: a visual tool for dietary phosphate management in dialysis and CKD patients. BMC Nephrol. 2015;16:9.PubMedPubMedCentralCrossRef
196.
Girelli D, Olivieri O, Stanzial AM, et al. Low platelet glutathione peroxidase activity and serum selenium concentration in patients with chronic renal failure: relations to dialysis treatments, diet and cardiovascular complications. Clin Sci (Lond). 1993;84(6):611–7.CrossRef
197.
Huang X, Sjögren P, Ärnlöv J, et al. Serum fatty acid patterns, insulin sensitivity and the metabolic syndrome in individuals with chronic kidney disease. J Intern Med. 2014;275(1):71–83.PubMedCrossRef
198.
Saikumar JH, Kovesdy CP. Bicarbonate Therapy in End-Stage Renal Disease: Current Practice Trends and Implications. Semin Dial. 2015. doi: 10.​1111/​sdi.​12373. [Epub ahead of print].
199.
Ciarambino T, Ferrara N, Castellino P, Paolisso G, Coppola L, Giordano M. Effects of a 6-days-a-week low protein diet regimen on depressive symptoms in young-old type 2 diabetic patients. Nutrition. 2011;27(1):46–9.PubMedCrossRef
200.
Paes-Barreto JG, Silva MI, Qureshi AR, Bregman R, Cervante VF, Carrero JJ, Avesani CM. Can renal nutrition education improve adherence to a low-protein diet in patients with stages 3 to 5 chronic kidney disease? J Ren Nutr. 2013;23:164–71.PubMedCrossRef
201.
Pisani A, Riccio E, Bellizzi V, et al. 6-tips diet: a simplified dietary approach in patients with chronic renal disease. Clin Exp Nephrol: A clinical randomized trial; 2015 [Epub ahead of print].
202.
203.
Porta N, Bonet C, Cobo E. Discordance between reported intention-to-treat and per protocol analyses. J Clin Epidemiol. 2007;60(7):663–9.PubMedCrossRef
204.
Metadata
Title
Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?
Authors
Giorgina Barbara Piccoli
Irene Capizzi
Federica Neve Vigotti
Filomena Leone
Claudia D’Alessandro
Domenica Giuffrida
Marta Nazha
Simona Roggero
Nicoletta Colombi
Giuseppe Mauro
Natascia Castelluccia
Adamasco Cupisti
Paolo Avagnina
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2016
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-016-0275-x

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