Low protein diets are not needed in chronic renal failure

Low protein diets have been used for a long time in the conservative manage ment of chronic renal failure as they have a beneficial effect in preventin g the appearance of symptoms. However, with the exception of the beneficial effect on hyperphosphatemia of the very low protein diets supplemented wit h ketoacids, they have no proven effects on the other aspects of the uremic syndrome. Moreover, the weight of the evidence suggests that the effect of these diets on preservation of GFR, if any, in patients with nondiabetic r enal disease is small and of little clinical relevance. There is very littl e evidence in the literature of its role in patients with diabetes. The nut ritional safety of these diets is still suspect. Patients with chronic rena l failure have low energy intakes, which is further reduced when these diet s are prescribed. Metabolic studies predict that these patients would be in negative nitrogen balance and in fact, even nutritionally sound, nondiabet ic patients enrolled in the Modification of Diet in Renal Disease Study dev eloped subclinical signs of malnutrition. It is possible that the nutrition al decline may have been more pronounced on longer duration of follow-up. F inally, these diets are difficult to follow, leading to issues of complianc e and exert a great toll on the time of the dietitians. Hence, we conclude that low protein diets are not necessary in chronic renal failure. Copyrigh t (C) 2000 S. Karger AG, Basel.