Abstract
This manuscript is aimed at summarising the evidences raised by the 2nd International conference of the European Renal Nutrition (ERN) working group at the ERA-EDTA
Editorial: European Renal Nutrition (ERN) (ERA-EDTA)
Protecting the kidneys from hyper-filtration and fibrosis remains the most powerful tool to prevent progression towards end-stage renal disease. Among many effective interventions such as blood-pressure monitoring, glycaemic control and ace inhibitor-proteinuria management, reducing protein intake will help to spare kidney work. Indeed, a lower protein intake will also reduce proteinuria, limit interstitial inflammation and subsequent kidney fibrosis at earlier stages of renal disease. By limiting protein degradation products such as phosphate, urea, NH4 and uric acid, the kidney will reduce its energy expenditure for concentrating all these solutes and getting rid of them. Later, when renal failure installs, many metabolic disorders will be improved if the protein load is reduced. Thus, dietary protein control remains an important part of the therapeutic toolbox of nephrologists.
The recently European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) approved European Renal Nutrition (ERN) working group (www.era-edta.org) is dedicated to foster knowledge in nutrition and metabolism during kidney disease. Preventing the alterations of chronic kidney disease (CKD) by dietary interventions is one of the major challenges to address. The course organised by Dr. Bellizzi and colleagues in Naples, Italy, September 20–21, 2016 will certainly summarise all important and new information on this topic as it appears in this special issue of
Purpose of the current ERN Meeting
CKD has been recently included among the major chronic non-communicable epidemic diseases because of its increasing prevalence (estimated prevalence in the general adult population around 7%–14%, depending on the country), its severe prognosis and its associated dramatic reduction in both life expectancy and quality of life (4). CKD also incurs elevated healthcare costs, nowadays unsustainable for many countries.
During CKD, the loss of renal function and progression towards end-stage renal disease can be attenuated and effectively managed with appropriate intervention. Indeed, recent studies have shown the possibility to stop, or at least to slow down, the negative progression of CKD toward dialysis, by acting during the early stages with multifactorial intervention, either pharmacological or nutritional; in this strategy nutrition and dietetics play a pivotal role (5).
This international conference will provide an in-depth analysis of comprehensive nutritional management in non-dialysis-dependent CKD. They will cover either nutritional strategies to retard CKD progression, delaying the need of renal replacement therapy, or nutritional habits to improve metabolic complications of renal disease, avoiding other uraemia-related complications and reducing the cardiovascular risk.
Nutritional treatment of CKD is a complex therapeutic intervention that requires multidisciplinary team work, including the work of nephrologists, nutritionists, endocrinologists and dieticians (6). This scientific conference is addressed to all these professionals, providing timely and updated information on the relationship between the nutrients, foods and kidney disease, and deciphering how their interaction can reduce metabolic complications, retard CKD progression and improve the overall health status of non-dialysis CKD patients.
Purpose of Nephrology@Point of Care
A practical nutritional approach for a common non-dialysis CKD patient: a case report
This is the case report of a male patient, aged 64 years, nonsmoker at first discovering chronic renal failure which was regularly followed in a CKD nephrology clinic. In the patient's family there was a history of diabetes mellitus; the patients himself was affected by type 2 diabetes mellitus (for around 14 years; on insulin for 10 years), complicated by neuropathy and retinopathy; the patient also suffered from hypertension (for 15 years), hepatitis C virus (HCV)-related chronic liver disease; CKD was recently discovered. The patient underwent comprehensive, multifactorial nephrology care, including nutritional treatment, for a long period. The aim of the current project is to provide the reader with a point-of-care approach to nutrition management of CKD addressing the following burning questions:
Baseline nutritional assessment and basic nutritional considerations in non-dialysis CKD
– What nutritional assessment/monitoring for protein energy wasting (PEW) for this patient?
– What is the optimal body mass index (BMI) in CKD?
– What phosphate target level should we pursue?
– How should we approach normal serum phosphate?
– What are the nutritional habits of incident CKD patients? Specific consideration for this patient?
– What is the protein need and what is the optimal amount of dietary protein to suggest?
– Does the quality of protein matter?
– What is the optimal amount of dietary salt to suggest? How to obtain it?
– What diet first? Is a vegetarian diet an option?
Major nutritional targets in non-dialysis CKD
– Is this reduction of body weight within “normal” protective for CKD progression?
– What is the impact of renal dietitian on adherence to a renal diet?
Nutritional follow-up in non-dialysis CKD
– What is the optimal treatment for CKD-mineral and bone disorder (MBD) and what is the impact on CKD progression?
– Does dietary recall/intensive dietary education improve the diet adherence?
– Is a very low-protein diet/ketodiet indicated in CKD?
Footnotes
Acknowledgment
The European Renal Nutrition Working Group is an initiative of and supported by the European Renal Association - European Dialysis Transplant Association.
Financial support: No grants or funding have been received related to this study.
Conflict of interest: None of the authors has financial interest related to this study to disclose.