Low-protein diets in the treatment of chronic renal failure

Dietary protein restriction is an established method of preventing the symptoms of uremia but three questions should be asked before beginning this type of therapy: Will the diet maintain adequate nutrition? Can compliance be monitored? Will the low-protein diet prevent uremic symptoms and change the course of the disease? There are positive answers to these questions. Recently it has been shown that the metabolic acidosis associated with kidney failure causes catabolism by increasing the degradation of muscle protein and of essential amino acids. The mechanism for these responses includes increased mRNAs encoding enzymes involved in catabolic pathways. Activation of these pathways would impair the ability of patients to respond to a low-protein diet because the ability to reduce the oxidation of essential amino acids and degradation of protein would be limited.