If you read my last post, you know that I am answering a question posed by Danielle from BC about how protein intake impacts kidney function decline.
For brevity’s sake, my last post just talked about 0.55-0.66g/kg protein and I didn’t get into the more restrictive diet of aiming for closer to 0.3g/kg protein and using keto analogue supplements, despite it being bullet point two in the KDOQI guidelines. So let’s get into that now.
Experience Disclaimer
I have never done this in my clinical practice. For the past several years I was working in dialysis and I only just switched over to pre-dialysis CKD this summer. And as of yet, I haven’t had a single referral or patient ask about this. However – I have heard that this treatment is used quite frequently in parts of the world where dialysis is less available than it is in Canada.
Ok so why does KDOQI this is a viable option?
I took a look at the evidence that KDOQI cites in their guidelines to understand what they had reviewed to make this recommendations. Specifically they talk about two studies that they pooled together and found that very low protein diets with keto analogues were protective against starting dialysis.
Interesting both of these studies were comparing very low protein (~0.3g/kg) to low (~0.6g/kg) protein diets. And in one case the participants started on the 0.6g/kg diet and only if they were compliant and doing well following the 0.6g/kg diet, were they given the option to switch into the more restrictive diet.
Lets look at some numbers
| Reference | Number initiating dialysis on VLPD | Number initiating dialysis on LPD |
| Mircescu et al, 2007 | 1 out of 27 (3.7%) | 7 out of 26 (27%) |
| Garneata et al, 2016 | 11 out of 104 (10.6%) | 22 out of 103 (21.4%) |
| Totals | 12 out of 131 (9.2%) | 29 out of 139 (20.9%) |
What does this table mean?
It cut the rates basically in half!
This means that 1 out of 10 patients on the very low protein diet with keto-analogues compared to 1 out of 5 patients on the low protein diet started dialysis.
Take Aways
I have never done this diet in clinical practice but the evidence is pretty convincing. The studies acknowledged that you likely need to be working with motivated patients – but it would be an interesting option to be able to offer to clients.
The draw backs I think I hear from clinicians is the support of our practice environments to provide adequate nutrition monitoring, accessing the keto-analogues and even comfort with how do we translate that into recommendations that patients can follow.
But I would love to hear your experience and opinions. Are you using it in your clinics? How is it going?
Wait – what if I am worried about my patient’s not eating enough? Very low protein diets for them too?
Good question – read more here.
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