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Diet or dialysis in the elderly? The DODE study: a prospective randomized multicenter trial
R Maiorca1, G Brunori, B F Viola
1Institute and Division of Nephrology, University School of Medicine and Spedali Civili, Brescia, Italy. maiorca@master.cci.unibs.it
Journal of Nephrology
|August 18, 2000
Summary
Early dialysis initiation lacks proven benefit, while a very-low-protein diet (VLPD) with supplements may slow kidney disease progression. This approach could potentially improve survival and quality of life for elderly patients compared to dialysis.
Area of Science:
- Nephrology
- Geriatric Medicine
- Nutritional Science
Background:
- Current guidelines (NKF-DOQI) recommend early dialysis initiation, but evidence for its benefit is limited.
- Uremic patients often present with poor nutritional status, making it difficult to attribute nutritional decline solely to residual renal function or diet.
- Elderly patients, who form a significant portion of dialysis initiators, face higher morbidity, mortality, and hospitalization rates.
Purpose of the Study:
- To investigate whether an amino acid-supplemented very-low-protein diet (VLPD) can be extended beyond recommended glomerular filtration rate (GFR) limits.
- To compare the survival and quality of life outcomes of elderly patients on an extended VLPD versus standard dialysis.
- To evaluate the efficacy of a vegetarian VLPD with essential amino acids and keto-analogs in preventing hypoalbuminemia and slowing chronic kidney disease (CKD) progression.
Main Methods:
- A prospective, randomized trial is proposed to compare outcomes in elderly patients.
- Patients will initiate intervention at GFR values typically recommended for starting dialysis.
- The study will compare a vegetarian VLPD supplemented with keto-analogs and essential amino acids against standard dialysis.
Main Results:
- Preliminary findings suggest that a VLPD with essential amino acids and keto-analogs, alongside adequate calories, can prevent hypoalbuminemia at dialysis initiation.
- This dietary approach may slow the progression of chronic renal failure.
- Hospitalization rates tend to increase after dialysis initiation compared to the pre-dialysis period.
Conclusions:
- Solid data on the true advantage of early dialysis initiation are lacking.
- An amino acid-supplemented VLPD may offer a viable alternative or delay for elderly patients, potentially improving survival and quality of life.
- Further randomized trials are necessary to confirm the benefits of extended VLPD over dialysis in this population.