Diet or dialysis in the elderly? The DODE Study: a prospective randomized multicenter trial

There are no solid data on the real advantage of an early start of dialysis , as suggested by the DOQI guidelines. Uremic patients frequently have a po or nutritional status. However, we cannot distinguish between the detriment al effect on nutrition of too low a residual renal function or too long a p eriod of low protein-diet, per se. However, it appears that a very-low-prot ein diet (VLPD) supplemented with essential amino acids and keto-analog of amino acids, and with an adequate quantity of calories, can prevent hypoalb uminemia at the start of dialysis and can slow the progression of chronic r enal failure, EDTA and USRDS data suggest that most patients starting dialysis nowadays a re elderly, who also have the highest incidence of morbidity and mortality. Moreover, hospitalization rate becomes higher after the start of dialysis compared to the pre-dialysis period. Can an aminoacid-supplemented VLPD, prolonged beyond the GFR limits suggest ed by DOQI, offer elderly patients better survival and better quality of li fe than dialysis? The answer can only come from a prospective, randomized t rial, in elderly patients, starting at the GFR values suggested by the NKF- DOQI for starting dialysis, comparing outcomes with a vegetarian VLPD suppl emented with a mixture of keto-analog of amino acids and essential amino ac ids, and with dialysis.