Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?
| Autor: | Giorgina Barbara Piccoli, Marta Nazha, Federica Neve Vigotti, Paolo Avagnina, Elena Mongilardi, Elisabetta Versino, Marilisa Bilocati, Irene Capizzi |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Nephrology Low protein medicine.medical_treatment 030232 urology & nephrology costs registry 0302 clinical medicine low protein diet 80 and over Medicine Renal Insufficiency 030212 general & internal medicine Chronic Aged 80 and over education.field_of_study Nutrition and Dietetics Mortality rate dialysis start mortality standardized mortality ratio Disease Progression Female Dietary Proteins lcsh:Nutrition. Foods and food supply medicine.medical_specialty Longevity Population Renal function Protein-Restricted lcsh:TX341-641 Article 03 medical and health sciences Renal Dialysis Internal medicine Costs Dialysis start Low protein diet Mortality Registry Standardized mortality ratio Aged Humans Renal Insufficiency Chronic Diet Protein-Restricted Food Science education Dialysis business.industry medicine.disease Diet Surgery business Kidney disease |
| Zdroj: | Nutrients; Volume 8; Issue 12; Pages: 758 Nutrients, Vol 8, Iss 12, p 758 (2016) Nutrients |
| ISSN: | 2072-6643 2007-2015 |
| DOI: | 10.3390/nu8120758 |
| Popis: | The indications for delaying the start of dialysis have revived interest in low-protein diets (LPDs). In this observational prospective study, we enrolled all patients with chronic kidney disease (CKD) who followed a moderately restricted LPD in 2007-2015 in a nephrology unit in Italy: 449 patients, 847 years of observation. At the start of the diet, the median glomerular filtration rate (GFR) was 20 mL/min, the median age was 70, the median Charlson Index was 7. Standardized mortality rates for the "on-diet" population were significantly lower than for patients on dialysis (United States Renal Data System (USRDS): 0.44 (0.36-0.54); Italian Dialysis Registry: 0.73 (0.59-0.88); French Dialysis Registry 0.70 (0.57-0.85)). Considering only the follow-up at low GFR (≤15 mL/min), survival remained significantly higher than in the USRDS, and was equivalent to the Italian and French registries, with an advantage in younger patients. Below the e-GFR of 15 mL/min, 50% of the patients reached a dialysis-free follow-up of ≥2 years; 25% have been dialysis-free for five years. Considering an average yearly cost of about 50,000 Euros for dialysis and 1200 Euros for the diet, and different hypotheses of "spared" dialysis years, treating 100 patients on a moderately restricted LPD would allow saving one to four million Euros. Therefore, our study suggests that in patients with advanced CKD, moderately restricted LPDs may allow prolonging dialysis-free follow-up with comparable survival to dialysis at a lower cost. |
| Databáze: | OpenAIRE |
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