Outcome of nutritional status and body composition of uremic patients on avery low protein diet

Concern has been raised about the nutritional adequacy of a very low protei n diet (VLPD). Monthly clinical evaluation by a physician and dietitian and quarterly dietary records, anthropometric measurements, blood testing, and dual energy X-ray absorptiometry (DEXA) were used to assess the course of nutritional status for 1 year in 10 clinically stable patients (six men, fo ur women; age, 57.1 +/- 9.3 years) with advanced chronic renal failure (mea n glomerular filtration rate, 13.2 +/- 4.8 mL/min/1.73 m(2)). These patient s received a VLPD providing 0.3 g/kg/d of protein and were supplemented wit h amino acids and ketoanalogues. Conventional nutritional markers remained unchanged after 1 year of the VLPD. However, during the same period, whole- body DEXA showed a significant decrease in lean tissue from 46.2 +/- 10.2 t o 45.0 +/- 9.8 kg (P < 0.02); limb trunk lean tissue ratio was reduced from 0.86 +/- 0.12 to 0.82 +/- 0.12 (P < 0.02), total-body fat increased from 2 0.0 +/- 6.9 to 21.4 +/- 7.0 kg (P < 0.05), and the percentage of total-body fat increased from 29.2% +/- 8.7% to 31.7% +/- 8.8% (P < 0.03). These diff erent modifications occurred abruptly during the first 3 months, then stabi lized or slightly improved thereafter. These mild changes do not appear to be deleterious given the favorable long-term outcome of these patients, eve n after they began treatment by dialysis or after renal transplantation. (C ) 1999 by the National Kidney Foundation, Inc.