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Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis.

J Coresh, M Walser and S Hill
JASN November 1995, 6 (5) 1379-1385;
J Coresh
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M Walser
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S Hill
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Abstract

Concerns have been raised about the possibility of protein restriction resulting in malnutrition and poor subsequent survival on dialysis. However, no studies have examined patients treated with protein restriction to determine their subsequent survival on dialysis. This study prospectively monitored 67 patients with established chronic renal failure (mean initial serum creatinine of 4.3 mg/dL) who were treated with a very low-protein diet (0.3 g/kg per day) supplemented with either essential amino acids or a ketoacid-amino acid mixture and observed closely for clinical complications. Forty-four patients required dialysis. Once dialysis was started, dietary treatment was no longer prescribed. The cumulative mortality rate during the first 2 yr after starting dialysis was 7% (95% confidence interval, 0 to 16%). During this period, only two deaths occurred compared with 11.5 deaths expected on the basis of national mortality rates adjusted for age, sex, race, and cause of renal disease (P = 0.002). However, the protective effect was limited to the first 2 yr on dialysis. Thereafter, mortality rates increased, resulting in a total of 10 deaths during 96.4 person-years of follow-up, which was not significantly lower than the 14.9 deaths expected (P = 0.25). Extrapolation of sequential serum creatinine measurements made before dietary treatment suggests that the improved survival cannot be due to the early initiation of dialysis. Although the lack of an internal control group and data on dialysis lends uncertainty, the large difference in mortality rate between these patients and the nationwide experience indicates that protein restriction and close clinical monitoring predialysis does not worsen and may substantially improve survival during the first 2 yr on dialysis. These findings point out the importance of studying predialysis treatments as a means for lowering mortality on dialysis.

  • Copyright © 1995 by American Society of Nephrology
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Journal of the American Society of Nephrology
Vol. 6, Issue 5
1 Nov 1995
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Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis.
J Coresh, M Walser, S Hill
JASN Nov 1995, 6 (5) 1379-1385;

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Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis.
J Coresh, M Walser, S Hill
JASN Nov 1995, 6 (5) 1379-1385;
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Cited By...

  • Current Uses of Dietary Therapy for Patients with Far-Advanced CKD
  • Long-term outcome on renal replacement therapy in patients who previously received a keto acid-supplemented very-low-protein diet
  • Application of Branched-Chain Amino Acids in Human Pathological States: Renal Failure
  • Diets For Patients With Chronic Kidney Disease, Still Worth Prescribing
  • Late Initiation of Dialysis among Women and Ethnic Minorities in the United States
  • Nutrition and Outcome on Renal Replacement Therapy of Patients with Chronic Renal Failure Treated by a Supplemented Very Low Protein Diet
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