Are supplemented low-protein diets nutritionally safe?

In patients with chronic renal failure (CRF), the reduction of dietary prot ein intake may correct uremic symptoms, slow the rate of progression of ren al failure, and delay the onset on dialysis. Concerns have been made on the nutritional consequences of protein-restricted diets. Over 15 years, 239 p atients were treated with a very-low-protein diet providing 0.3 g vegetable protein/kg/day supplemented (SLPD) with essential amino acids and keto ana logs. Many adverse consequences of uremia were corrected by this regimen, s uch as metabolic acidosis, secondary hyperparathyroidism, resistance to ins ulin, decreased Na+-K+-ATPase activity. A joint physician-dietitian monitor ing contributed to the maintenance or obtention of a satisfactory nutrition al status, even in patients at risk, diabetics, patients with the nephrotic syndrome and with renal allograft chronic rejection. The outcome of these patients when treated by hemodialysis or transplantation was favorable, the ir nutritional status being preserved. Results from the present study and r esults of other studies show that SLPD can be used in patients with advance d CRF without adverse effects in carefully selected and monitored patients. (C) 2001 by the National Kidney Foundation, Inc.