A practical guide for the use of very low calorie diets in adults with chronic kidney disease.

Obesity is increasingly common in individuals with chronic kidney disease (CKD). Being overweight or obese is associated with both the development and progression of kidney disease. Lifestyle interventions such as the use of very low-calorie diets (VLCD) are being used increasingly for patients with CKD despite warnings from manufacturers that they should be avoided or used with caution. Whilst these diets are effective and can induce rapid weight loss and suppress appetite, their use in patients with chronic and end stage kidney disease is more complex than in the general population. VLCD use in adults with kidney disease requires a more nuanced approach to prescription and closer monitoring for unintended side effects. This review describes the indications and clinical management of patients with CKD undertaking a very low-calorie diet and provides practical guidance regarding how to manage a VLCD, particularly for the latter stages of CKD.

Nutritional state correlates with renal function at the start of dialysis.

OBJECTIVE: To determine the effect of renal function at the commencement of dialysis on nutritional state. DESIGN: Retrospective cohort study. SETTING: University tertiary referral hospital. PATIENTS: Patients with end-stage renal disease commencing renal replacement therapy over 8.5 years. MAIN OUTCOME MEASURES: Total body nitrogen assessment using in vivo neutron activation analysis, expressed as nitrogen index (NI = observed total body nitrogen/predicted total body nitrogen); serum albumin measurement and creatinine clearance estimation, using the Cockcroft-Gault equation, at the start of dialysis. "Early" start group = creatinine clearance > 10 mL/minute (n = 26). "Late" start group = creatinine clearance < or = 10 mL/min (n = 108). RESULTS: Mean NI was significantly lower [95% confidence interval (CI) 6%-30%, p < 0.0001] in the late start group (NI = 88%) compared to the early start group (NI = 106%). The late start group also had a significantly lower (95% CI 0.06-0.47 g/dL, p = 0.02) mean serum albumin level (3.66 g/dL) compared to that of the early start group (3.93 g/dL). A positive independent correlation existed between renal function and total body nitrogen (r2 = 0.21, p < 0.0001). No other clinical or demographic variable at the start of dialysis was found to predict nutritional state. CONCLUSIONS: Patients that start dialysis with low levels of renal function are likely to be significantly malnourished. Whether this translates into a survival advantage requires prospective study.