ArticleNutrients2016
Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?
Article in Nutrients, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed.
- Trial
- Compound α-keto acid tablet supplementation alleviates chronic kidney disease progression via inhibition of the NF-kB and MAPK pathways.Journal of translational medicine · 2019Trial
- Trial
- Ketoanalogue-Supplemented Low-Protein Diet in Patients with Stage 4+ Chronic Kidney Disease in Italy: A Cost-Utility Analysis.Nutrients · 2026Article
- Combining Ketoacid Analog Supplemented Low-Protein Diets with Sodium-Glucose Cotransporter-2 Inhibitors for Patients with Diabetic Kidney Disease.Clinical journal of the American Society of Nephrology : CJASN · 2026Article
- Cost-effectiveness of a ketoanalogue-supplemented very low-protein diet in CKD.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2025Article
- Supplemented Very Low Protein Diet (sVLPD) in Patients with Advanced Chronic Renal Failure: Clinical and Economic Benefits.Nutrients · 2023Observational
- Food as medicine? Exploring the impact of providing healthy foods on adherence and clinical and economic outcomes.Exploratory research in clinical and social pharmacy · 2022Article
- Article
- Assessing Global Kidney Nutrition Care.Clinical journal of the American Society of Nephrology : CJASN · 2022Article
- Supplemented Low-Protein Diet May Delay the Need for Preemptive Kidney Transplantation: A Nationwide Population-Based Cohort Study.Nutrients · 2021Article
- Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis?Nutrients · 2020Article
- Dialysis Reimbursement: What Impact Do Different Models Have on Clinical Choices?Journal of clinical medicine · 2019Article
- The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions.BMC medical ethics · 2017Article
- Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The indications for delaying the start of dialysis have revived interest in low-protein diets (LPDs). In this observational prospective study, we enrolled all patients with chronic kidney disease (CKD) who followed a moderately restricted LPD in 2007-2015 in a nephrology unit in Italy: 449 patients, 847 years of observation. At the start of the diet, the median glomerular filtration rate (GFR) was 20 mL/min, the median age was 70, the median Charlson Index was 7. Standardized mortality rates for the "on-diet" population were significantly lower than for patients on dialysis (United States Renal Data System (USRDS): 0.44 (0.36-0.54); Italian Dialysis Registry: 0.73 (0.59-0.88); French Dialysis Registry 0.70 (0.57-0.85)). Considering only the follow-up at low GFR (≤15 mL/min), survival remained significantly higher than in the USRDS, and was equivalent to the Italian and French registries, with an advantage in younger patients. Below the e-GFR of 15 mL/min, 50% of the patients reached a dialysis-free follow-up of ≥2 years; 25% have been dialysis-free for five years. Considering an average yearly cost of about 50,000 Euros for dialysis and 1200 Euros for the diet, and different hypotheses of "spared" dialysis years, treating 100 patients on a moderately restricted LPD would allow saving one to four million Euros. Therefore, our study suggests that in patients with advanced CKD, moderately restricted LPDs may allow prolonging dialysis-free follow-up with comparable survival to dialysis at a lower cost.
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