ESPEN 2022 Late Breaking Abstracts

Topic: Nutrition and chronic disease

Abstract Submission Identifier: ESPEN22-LB-2159

VERY LOW-PROTEIN DIET SUPPLEMENTED: CLINICALS AND ECONOMICS BENEFITS IN PATIENTS WITH ADVANCED CHRONIC RENAL FAILURE.

C. Sofia^*, ¹, S. Di Stante ¹, F. Baldini ², M. Di Luca ³

¹UOC Nefrologia e Dialisi, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, ²National Research Council, Pisa, ³UOC Nefrologia e Dialisi, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy

Rationale: The low-protein diet effectively slows the progression of chronic kidney disease (CKD) and postpones the initiation of dialysis treatment. Our Center adopted a very low-protein diet (0.3 g/kg/day) supplemented with essential aminoacids, without ketoanalogs, in patients with eGFR <15 ml/min(1).

Methods: 110 patients were initiated for nutritional therapy (mean age 75.7+/-13.9, M 60.9%, diabetic 36.4%, heart disease 22.7%, all hypertensive) who were detected at the start of observation, every 3 months and for 24 months, characterizing blood chemistry tests and body composition.

Results: An improvement in azotemia (T0 vs T6; p<0.001) and uricemia values ​​was observed; stationarity of eGFR, electrolytes, and glycemia; maintenance within the expected values ​​for hemoglobin and albuminemia. The BMI remained on average, always within normal values with an improving trend in the body composition; there was no malnutrition signes. There were 18 deaths (9 patients over 85 years old), 17 entries in DP, 19 in HD, and 3 pre-emptive living transplants. 9 patients had functional recovery (eGFR> 15 mL/min). A total of 662 months of dialysis was avoided with an estimated economic saving of approximately € 1.5 million. There is a significant difference between compliant (91%) and non-compliant patients in preserving renal function and delayed entry into dialysis (Log Rank p<0.02).

Conclusion: Thanks to high compliance, we obtained a slowdown in the progression of CKD and improved metabolic, electrolyte, and body composition control, allowing patients to delay the start of dialysis. This resulted in an important economic saving estimated at around 21 thousand €/patient (around 2300 €/pt/month).

References: 1.A.Cupisti, G.Brunori, B.Di Iorio   et al. Nutritional diet therapy in the management of the patient with Chronic KidneyDisease in advanced phase to delay the beginning and reduce the frequency of dialysis. An option also in the pre-emptive transplant program. G Ital Nefrol. 2018 Sep;35(5):2018-vol5. 

Disclosure of Interest: None Declared

Keywords: nutritional treatment; very low-protein diet; dialysis; chronic renal failure