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Diet and enteral nutrition in patients with chronic kidney disease not on dialysis: a review focusing on fat, fiber and protein intake

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Abstract

The clinical data available on dietary requirements of patients with chronic kidney disease (CKD) not on dialysis are limited and largely inconclusive in terms of the renal, cardiovascular and nutritional outcomes achievable through dietary modifications. Restriction of protein intake during the early stages of CKD may in fact slow its progression, but at the same time this approach may also lead to protein-energy wasting, if energy intake is not adequate and properly monitored. Unfortunately, compliance to dietary recommendations is traditionally low in this patient population. A switch from saturated to mono- and polyunsaturated fats is generally recognized as advantageous for cardiac health; however, the benefits in term of renal function are largely unknown. Similarly, the association between dietary fiber intake and kidney disease is largely unknown. In fact, while there is evidence on the positive health effects of dietary fibers in the general population, nutritional guidelines for CKD lack formal recommendations concerning fiber intake. This paper reviews data and evidence from clinical trials and meta-analyses on renal and cardiovascular outcomes related to modifications in protein, fat and fiber intake. Suggestions for maintaining nutritional status through patient-oriented dietary patterns and enteral supplementation in CKD patients on conservative therapy are also presented.

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Acknowledgements

We thanks Mrs Carol Krcmar, RN MN for collaboration.

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Authors and Affiliations

  1. Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy

    Alice Sabatino, Giuseppe Regolisti, Filippo Fani & Enrico Fiaccadori

  2. Postgraduate School of Nephrology, University of Parma, Parma, Italy

    Ilaria Gandolfini, Marco Delsante & Enrico Fiaccadori

  3. Nephrology and Dialysis Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy

    Maria Cristina Gregorini

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  1. Alice Sabatino
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  2. Giuseppe Regolisti
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Sabatino, A., Regolisti, G., Gandolfini, I. et al. Diet and enteral nutrition in patients with chronic kidney disease not on dialysis: a review focusing on fat, fiber and protein intake. J Nephrol 30, 743–754 (2017). https://doi.org/10.1007/s40620-017-0435-5

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