Dietary interventions to improve outcomes in chronic kidney disease.

[Zach]

http://journals.lww.com/co-nephrolhypertens/Abstract/publishahead/Dietary_interventions_to_improve_outcomes_in.99450.aspx
Dietary interventions to improve outcomes in chronic kidney disease.

Abstract
Purpose of review: Chronic kidney disease (CKD) is a major epidemic which has global outcomes with increased morbidity and mortality. Given the global implications of CKD, interventions that target modifiable risk factors for CKD are needed. Despite the effectiveness of kidney protection strategies such as hypertension and lipid control as well as the use of antiangiotensin II drugs, the nephropathy in many patients with CKD and reduced glomerular filtration rate (GFR) nevertheless continues to progress toward complete kidney failure. More concerning, CKD-related deaths and in years of life lost due to CKD continue to increase. In this article, we will explore the dietary interventions that recent small-scale studies support slowing the progression of CKD.

Recent findings: Dietary acid reduction with Na+-based alkali has been shown to be an effective kidney protection strategy for CKD patients with reduced GFR. In addition, recent analyses support diet as the largest CKD-related death and disability risk factor. Small-scale studies show that diets which emphasize ingestion of plant-sourced protein more than animal-sourced protein reduce dietary acid, improve metabolic acidosis, and slow further nephropathy progression in patients with CKD and reduced GFR.

Summary: Dietary interventions are underused as kidney protection strategies. As further studies better define how to best use these dietary interventions for kidney protection, clinicians must become aware of their potential utility in the management of CKD patients.

Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

[kristina]

Thank you Zach for this most important article.
I am very glad about this important dietary research ... and the medical Professor I consulted in 1971/1972 also believed,
that a vegetarian diet could have a very positive effect on my suffering from Chronic Proliferative Glomerulonephritis
and perhaps he was right, because with this vegetarian diet I made it another 43 years before I had to start with dialysis ...
... I am so glad that all this is now being seriously researched and published ...
Thanks again for sharing this most important article from Kristina.

[Athena]

Zach, thank you for putting this article out here. It's a subject so many of us grapple with with CKD and it's something that is constantly asked of Nephs & dieticians. I've done my rounds with 2 Nephs and a renal dietician and the resounding verdict is that vegetarianism is not proven to slow kidney disease progression. Have you always followed a vegetarian diet yourself?

[MooseMom]

This study baffles me, and I have no idea why this is a "new" source of information.

We've known for years that animal protein is harder on the kidneys, but the question really is from which other sources does one get protein.  This study mentions in passing "plant based protein" doesn't tell us which plants will provide sufficient protein without sending potassium or phosphorus levels into the stratosphere.

Is this a mere case of "publish or perish"?

[MuddyGurl]

Hi Zach..great post.  I have at least a dozen similar  STUDIES and have learned a bit ABOUT why there is such a disconnect in the USA vs Europe/CHina/Sweden using a sVLP  veggie diet to delay dialysis, and also keep people healthier DURING dialysis. ( will post you several links to read)

What MOST people, Nephs included,(my OWN Neph says VLP has been debunked (wtf?)  but she and others do not understand is the study they point to as "confirming" low protein/no meat 'doesn't work" was the  MDRD  done in 1990s.   They do NOT know all that went wrong on this study.

THE BACKSTORY* tells us it was unfortunately the biggest  political and technical F-up of $100M dollars ever.  NO USA Neph  promotes  this diet with amino acids added..but in China they have 50million  people  with CKD, many who need dialysis soon, and they are  following the diet.  As are thousands on Swedes and others in Europe. Because the COSTS are beyond enormous.  These  Intl. docs didn't toss out what was good about the idea of sVLP…they  further studied it, ran with it. (Yet  USA docs do NOT attend Intl. Renal Nutrition conferences..since they "know better"… oh really? (*documented by Dr. Walser post study)

Now only Dr. Bill Mitch at UTx Baylor is speaking and teaching of this diet in the USA. Look up "WE Mitch" in Pubmed to find MANY VLP studies)

Dr. Walser who created sVLP, and fought hard for MDRD to happen, and  created the blanced Amino Acids formulation, then in Europe Fresnius commercially adapted them, and they sell millions of patient doses all over.( Keto Acids are so expensive, not paid for in USA, but are heavily used in Europe..due to the same politics)

WHY MDRD gave an "inconclusive" result:
in the MDRD the PATIENTS lied about protein consumed (ate 138-178% OVER allowance in both groups)  and didn't  take the AAs as prescribed. A company substituted their own AA formula, not the Jophns Hoplins one as designed,   and never mentioned it to the researchers!!!!    Next were political and ego games among the doctors..bad blood all  around.  Other mistakes and problems, so in the end it was truly a "waste" of effort and gov funds on a massive scale-proving gov. committee thinking does not work.

if the patients DIDN'T follow a VLP diet, didnt use the aminos, then how can we say it didnt work?? It wasn't studied correctly all throughout.  yet all that is "known" in public is the "poor" findings.  The International Renal and Nutrition doctors choose to  use this vegetarian diet for their patients first to slow dialysis needs, and  reduce huge  treatment costs. ( In the USA it costs 3x as much annually for dialysis  patients vs transplant patients. But no, diet is never considered here!! and we all know donors are rare.
 
we are up 600% in amount of patients needing dialysis, and new research expects fully 50% of the Medicare budget will  be absorbed in ESRD costs by 2050.
 
400K  US patients get clinical dialysis, BUT 100K+ illegal aliens have learned to use the ERs in TX and border states for weekly life saving dialysis..which also COSTS triple standard clinic care..by our laws none are turned away, they know enough to show up at the ER and get treatments, just enough to stay alive.  Taxpayers foot the bill.

with 70% of us fat and obese, with diabetes and CVD rising…plus we won't give up burgers, fries, and  diet soda…no wonder it looks grim.

10,000 Boomers a DAY TURN 65-- GO ON MEDICARE. THIS WILL CONTINUE FOR 18 MORE YEARSS..365 DAYS A YEAR,  WITH 10,00 more  A DAY NOW ON MEDICARE… with "free" ESRD care..who will pay? how can we possibly pay?
++++++++++++++++++

I'm following the Walser's sVLP  20 gr protein a day protocol, vegetarian diet (not yet Vegan as I am still learning this ) I take  the special essential AA's  from Calwood Nutrionals and am doing all I can to  keep my one CKD Stage 4 kidney going.  I have 2, soon 3, recorded renal results showing I drop 7-9 pts in eGFR every time I eat meat..and I go back up as soon as I stop.

yet my VA Neph is pushing me to add MORE meat, but telling me to stop certain veggies as too high in phos & pot.   when combining meat and veggies you DO get too much Phos & Pot…but not on a veggie diet alone. ( almost all foods have Phosphorous..meat is especially high, you can see where this leads…..

Nephs do not want you malnourished when dialysis time comes, it looks bad if you present "too sick", and  then die on their watch…so they push meat, and dismiss Walser/MDRD.
+++++++++++++++++
Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. http://www.ncbi.nlm.nih.gov/pubmed/11729245
Yearly costs for treating a patient on HD are nearly triple the costs for treating a transplant patient
Between 1980 and 2009, the prevalent rate for ESRD increased nearly 600 percent, from 290 to 1,738 cases per million.
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Keto Acid Supplements May Help CKD Patients
http://www.renalandurologynews.com/nutrition/keto-acid-supplements-may-help-ckd-patients/article/174428/

Acidic, Meat-Based Diet Boosts Kidney Failure
http://www.renalandurologynews.com/end-stage-renal-disease/acidic-meat-based-diet-boosts-kidney-failure/article/398197/

Patients struggling with chronic kidney disease who routinely consume meat-rich, highly-acidic diets may boost their risk for kidney failure, according to research published online Feb. 12 in the Journal of the American Society of Nephrology.
Tanushree Banerjee, Ph.D., of the San Francisco General Hospital

​HERE IS THE ARTICLE - http://www.biomedcentral.com/content/pdf/1471-2369-15-137.pdf
 abstract-  ​http://jasn.asnjournals.org/content/early/2015/02/11/ASN.

>>ANOTHER one claiming MDRD study proved "no benefit"
Very Low-Protein Diets of No Benefit  <<< "alarmist title given on MDRD study
http://www.renalandurologynews.com/chronic-kidney-disease-ckd/very-low-protein-diets-of-no-benefit/article/127341/
But STILL SAY THIS:  “Although very low-protein diets generally are not recommended,” the investigators wrote, “we believe these findings are clinically relevant given the continued interest in the use of dietary protein restriction as an intervention to delay progression of kidney disease.”

***Group urges county to provide dialysis to illegal immigrants       <<dozens more stories we never hear about on Ilegal  alien ESRD
http://www.chron.com/news/houston-texas/article/Group-urges-county-to-provide-dialysis-to-illegal-1495532.php  (this is from 10 YEARS ago…$1.8 M for  just 60 illegal patients in the ER)