Low protein diets and outcome of renal patients

Protein-restricted diets have been proposed in patients with chronic renal failure (CRF) to correct uremic symptoms and to slow the progression of CRF thus delaying the initiation of dialysis. Questions have been raised about the compliance to such diets, their nutritional safety and efficacy. In two-thirds of selected and motivated patients, satisfactory compliance is observed; however, in the overall predialysis population, compliance is fair and does not exceed 50%. When patients are carefully monitored, protein-restricted diets, rather than inducing malnutrition, may prevent it. Moreover, the outcome of these patients, when treated by dialysis, is not affected by prior dietary prescription. A small but real beneficial effect of low protein diet (LPD) on the rate of progression of CRF is observed in nondiabetic renal diseases, but their beneficial effect seems to be greater in diabetic renal disease. Meta-analyses confirm that LPD can effectively postpone renal replacement therapy by moderately slowing the decline in GFR and also by substantially delaying the onset of uremic symptoms.