Less Protein: Fewer Deaths

Less Protein: Fewer Deaths

LESS PROTEIN
MAY REDUCE DIALYSIS DEATHS

Scientists at Johns Hopkins Medical Institutions
have found that a low-protein diet before dialysis may prolong the lives of
kidney failure patients during their first two years of dialysis. The findings
also suggest the diet may postpone the start of dialysis for some patients.

The Hopkins team studied 44 patients placed on a

special supplemented diet and given dietary counseling at

least four months before dialysis began. During the first

two years of dialysis, two patients died. National

statistics predict 11 to 12 deaths in a group this size.

"The study suggests that changes in pre-dialysis care

could reduce the number of deaths on dialysis

substantially," says Josef Coresh, MD, PhD, the study's lead

author, an assistant professor of epidemiology.

Protein restriction, with or without dietary

supplements, has long been studied as a way to prevent

kidney failure. But this study, funded by the National

Institutes of Health, is the first to show the death rate on

dialysis is lowered by a very low-protein diet with ketoacid

and amino acid supplements and close clinical monitoring

before dialysis, the scientists say.

"The diet not only worked but also prevented

malnutrition in most patients. In some cases, it reversed

it," says Coresh.

The results of the research, which are published in the

current issue of the Journal of the American Society of

Nephrology, suggest that a broader study of the diet is now

warranted, says Mackenzie Walser, MD, the study's senior

author, a professor of medicine and pharmacology.

Researchers cannot explain why the restrictive diet helps

but say it appears to prepare patients for the rigors of

dialysis. The 44 study patients ate no meat, fish, poultry,

eggs, milk, or cheese. They took tablets of amino acids or

synthetic substitutes to make up for the lack of essential

components normally provided by protein.

The kidneys filter the blood, reabsorb important

components, and excrete into the urine the protein breakdown

product: urea, excess minerals, toxins and fluid. Low

levels of protein in the blood are a strong predictor for

death in dialysis patients. An earlier Hopkins study showed

that the scientists' very low protein diet produces normal,

rather than low, levels of bloodstream protein at the start

of dialysis.

"We think the diet eliminates some component of

high-protein foods that makes it difficult for kidney

patients to metabolize protein properly," says Walser.

The diet can be followed by most chronic kidney failure

patients, and the essential amino acid supplements are

commercially available and cheaper than the foods they

replace, according to Walser.

For the past decade, the number of kidney patients has

increased about 11 percent each year. About 200,000 people

currently undergo dialysis, a technique to remove waste

products and excess fluid from the body as a treatment for

kidney failure. About 80,000 Americans die each year from

complications on dialysis.