Low-protein diet for chronic kidney disease in the Caserta Local Health Unit: the SaniARP Initiative

INTRODUCTION: In clinical practice, the interest in the use of low-protein food for patients suffering from chronic kidneydisease has increased. Currently, these products are not yet contemplated in the essential levels of assistance but the Italian regions deliver, low-protein food discretionally using their own funds. The Campania Region, in 2010, interrupted the distribution of these products. With the exception of Caserta which took up distribution again in 2013. OBJECTIVE: The aim of this paper is to describe an initiative put in place by Caserta which has decided to invest in prevention. MATERIALS AND METHODS: A treatment plan for the distribution designed by a team of in-house nephrologists and data are recorded using Saniarp, a web-based platform. RESULTS: In the observation period patients with a prescription of low-protein food products were 869. The mean age was 61 years. The average cost patient / month for the nutritional treatment was 59 Euro. The average cost patient / month for any type of drug was 632 Euro. In particular, 48 Euro for EPO, 277 Euro for Chelate Agents, 16 Euro for antihypertensive therapy. DISCUSSION AND CONCLUSIONS: The policy put in place by the LHU Caserta improved care of kidney patients. The results available to date are still incomplete and do not enable us to clearly assess the benefits both in clinical and economic terms which can be produced by a low-protein diet in kidney patients. In the perspective of third party payers to budget this expense it appears entirely sustainable especially in view of the fact that this dietary treatment might delay the onset of dialysis therapy and lead to lower comorbidity for the patient.

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Protein losing enteropathy associated with Nippostrongylus brasiliensis infestation and its impact on albumin homoeostasis in rats fed two levels of dietary protein

Clinical Science ◽

10.1042/cs0700469 ◽

1986 ◽

Vol 70 (5) ◽

pp. 469-475 ◽

Cited By ~ 12

Author(s):

P. G. Lunn ◽

C. A. Northrop ◽

R. H. Behrens ◽

J. Martin ◽

M. Wainwright

Keyword(s):

Protein Diet ◽

Low Protein Diet ◽

Albumin Concentration ◽

Nippostrongylus Brasiliensis ◽

Protein Loss ◽

Plasma Albumin ◽

Protein Food ◽

Protein Losing Enteropathy ◽

Low Protein ◽

Plasma Albumin Concentration

1. Alterations in plasma albumin concentration and gastrointestinal permeability have been investigated in rats infected with the nematode Nippostrongylus brasiliensis and fed adequate or low protein diets. 2. Infection caused only minor changes in growth and food consumption of well nourished rats but resulted in significant reductions in those fed the low protein diet. 3. Animals in both dietary groups were able to mount an immune response beyond day 10 postinfection (p.i.) which caused expulsion of the parasites, but this was less effective in rats fed the low protein food. 4. Uninfected rats fed the low protein diet had significantly lower plasma albumin concentrations than their well nourished counterparts. Animals of both dietary groups showed a progressive reduction in plasma albumin concentration as the infection developed but values returned towards normal as the parasites were expelled. 5. The reduction in plasma albumin concentration was closely associated with increases in gastrointestinal leakage of plasma protein but losses were far greater in the protein deficiency animals. Beyond day 10 p.i. protein loss decreased in both dietary groups and by day 21 p.i. had returned to normal in well nourished animals but not those fed the low protein diet. 6. Intestinal permeability measured by the lactulose:mannitol ratio technique gave similar results to the protein loss data. Permeability increased as the infection progressed then fell as the worms were expelled but remained above control values in infected protein deficient animals. 7. Overall, animals fed the low protein diet were more severely affected by the parasite than were their well fed counterparts. The data clearly demonstrated that the combined effects of infection and dietary deficiency resulted in a more severe reduction in plasma albumin values than either factor produced alone. The results are discussed with reference to the aetiology of hypoalbuminaemia and kwashiorkor in man.

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Hepatic Ultrastructure Changes Induced by Lithocholic Acid

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100060829 ◽

1967 ◽

Vol 25 ◽

pp. 162-163 ◽

Cited By ~ 1

Author(s):

F. G. Zaki

Keyword(s):

Endoplasmic Reticulum ◽

Lithocholic Acid ◽

Smooth Endoplasmic Reticulum ◽

Protein Diet ◽

Low Protein Diet ◽

Electron Microscopic ◽

Hydropic Degeneration ◽

Hepatic Cells ◽

Low Protein ◽

Microscopic Studies

Addition of lithocholic acid (LCA), a naturally occurring bile acid in mammals, to a low protein diet fed to rats induced marked inflammatory reaction in the hepatic cells followed by hydropic degeneration and ductular cell proliferation. These changes were accompanied by dilatation and hyperplasia of the common bile duct and formation of “gallstones”. All these changes were reversible when LCA was withdrawn from the low protein diet except for the hardened gallstones which persisted.Electron microscopic studies revealed marked alterations in the hepatic cells. Early changes included disorganization, fragmentation of the rough endoplasmic reticulum and detachment of its ribosomes. Free ribosomes, either singly or arranged in small clusters were frequently seen in most of the hepatic cells. Vesiculation of the smooth endoplasmic reticulum was often encountered as early as one week after the administration of LCA (Fig. 1).

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Ernährung bei chronisch Nierenkranken – Wie kann man eine Low-Protein-Diet erreichen?

Dialyse aktuell ◽

10.1055/s-0035-1555716 ◽

2015 ◽

Vol 19 (05) ◽

pp. 256-256

Keyword(s):

Protein Diet ◽

Low Protein Diet ◽

Low Protein

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Project report: the effect of maternal low protein diet on the neuromuscular system of the offspring in mice

10.36866/pn.101.11 ◽

2016 ◽

pp. 11-11

Author(s):

Ifigeneia Giakoumaki

Keyword(s):

Protein Diet ◽

Low Protein Diet ◽

Neuromuscular System ◽

Project Report ◽

Low Protein

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Economic Effects of Treatment of Chronic Kidney Disease with Low-Protein Diet

SSRN Electronic Journal ◽

10.2139/ssrn.2338432 ◽

2013 ◽

Author(s):

Francesco Saverio Mennini ◽

Simone Russo ◽

Andrea Marcellusi ◽

Giuseppe Quintaliani ◽

Denis Fouque

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Economic Effects ◽

Protein Diet ◽

Low Protein Diet ◽

Low Protein

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PSIV-6 Effect of a Phytogenic Water Additive on Growth Performance, Blood Metabolites and Gene Expression of Amino Acids Transporters in Nursery Pigs Fed with Low Protein Diets

Journal of Animal Science ◽

10.1093/jas/skaa278.507 ◽

2020 ◽

Vol 98 (Supplement_4) ◽

pp. 281-282

Author(s):

Cedrick N Shili ◽

Mohammad Habibi ◽

Julia Sutton ◽

Jessie Barnes ◽

Jacob Burchkonda ◽

...

Keyword(s):

Gene Expression ◽

Amino Acids ◽

Growth Performance ◽

Mrna Abundance ◽

Protein Diet ◽

Low Protein Diet ◽

Blood Calcium ◽

Low Protein ◽

Protein Diets ◽

Standard Protein

Abstract Moderately low protein (MLP) diets can help decrease nutrient excretion from the swine production. However, MLP diets negatively impact growth performance. We hypothesized that supplementing MLP diets with phytogenics may reduce the negative effects of these diets on growth. The objective of this study was to investigate the effect of a phytogenic water additive (PWA; Herbanimal®) on growth performance, blood metabolite and gene expression of amino acids transporters in pigs fed with MLP diets. Forty-eight weaned barrows were allotted to six dietary treatments (n = 8) for 4 weeks: >CON-NS: standard protein diet-no PWA; CON-LS: standard protein diet-low PWA dose (4 ml/L); CON-HS: standard protein diet-high PWA dose (8 ml/L); LP-NS: low protein diet-no PWA; LP-LS: low protein diet-low PWA dose (4 ml/L); LP-HS: low protein diet- high PWA dose (8 ml/L). Feed intake and body weight were recorded daily and weekly, respectively. At week 4, blood and tissue samples were collected and analyzed for metabolites using a chemistry analyzer and amino acid transporters using qPCR, respectively. The data were analyzed by univariate GLM (SPSS®) and the means were separated using paired Student’s t-test corrected by Benjamini-Hochberg. Pigs fed CON-HS improved the average daily gain and serum calcium and phosphorus concentrations compared to CON-NS. Pigs fed LP-LS had higher serum phosphorus and blood urea nitrogen compared to the pigs fed with LP-NS. The mRNA abundance of SLC7A11 in the jejunum was lower in CON-LS and CON-HS compared to CON-NS. Additionally, mRNA abundance of SLC6A19 in the jejunum of pigs fed with LP-LS was higher compared to LP-NS and lower in CON-HS relative to pigs fed with CON-LS. In conclusion, PWA improved the growth performance of pigs fed standard protein diets but not low protein diets. Further, the PWA improved the concentrations of blood calcium and phosphorous in pigs fed MLP diets. Funding: Agrivida and Animal Health and Production and Animal Products: Improved Nutritional Performance, Growth, and Lactation of Animals from the USDA-NIFA.

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