TORNA ALL’ELENCO

Survivalon low-protein diets: Results of a multiple choice approach in Nephrology Dialysis Transplantation

2013
AOU San Luigi di Orbassano

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (10)Vedi tutti...

Deagostini MC

Vigotti FN

Ferraresi M


et alii...

Abstract

Introduction and Aims: Concerns on the long-term safety of low-protein diets limit their use in Nephrology. In the discussion on the “best moment” to start dialysis, attention switched from slowing of the kidney function decline to the effects of delaying dialysis on survival. The aim of the study was to analyse survival in a cohort of patients treated by low-protein diets, followed in the same setting in December 2007-September 2012, with regard to baseline clinical conditions and low-protein diet chosen. Methods: Two main diets were offered, both at 0.6 g/Kg/day of proteins: a simplified low-protein supplemented diet (LPD-KA supplementation: Ketosteril 1/10 Kg) and a low-protein diet employing “aproteic” commercial food (LPD-ACF). Survival analysis was performed according to Kaplan Meier; multivariate analysis employed Cox model. The analysis took into consideration the period on the diet (up to dialysis start), or alternatively 1 year after the start of dialysis or the discontinuation of follow-up. Results: 285 patients started a LPD (167 LPD-KA and 118 LPD-ACF); the two groups were non homogeneous for age (median age LPD-KA: 68, LPD-ACF: 74 years p<0.0001) and GFR at start (LPD-KA: 18.8; LPD-ACF: 22.9 mL/min; p=0.0008); prevalence of comorbidity was high in both (68%, 94%) in line with the European population starting dialysis. No significant difference in patient survival was observed according to the diet (607 patient years; 353 on LPD-KA and 254 on LPD-ACF); patient survival was significantly influenced by age and comorbidity, not by gender or baseline GFR. Survival equivalence was confirmed prolonging follow-up up to one year after dialysis start or discontinuation. As for “renal survival” a significant advantage of LPD-ACF was found in univariate analysis; the effect is lost if the combined outcome of death-start of dialysis is analysed, underlining the differences between the two populations and suggesting a substantial equivalence betwe

DOI : 10.1093/ndt/gft108

Keywords

edetic acid; protein; ketosteril; protein restriction; multiple choice test; human; dialysis; survival; patient; diet; follow up; safety; population; comorbidity; mortality; proportional hazards model; Italy; multivariate analysis; death; univariate analysis; food; prevalence; hospital patient; gender; kidney function; register; supplementation; France; nephrology; policy;