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Low protein diets and nutritional therapies in CKD: investigating the current global trends

Nutritional interventions in chronic kidney disease (CKD) have been met with mixed reports. Strong supporters and determined adversaries have contributed to the controversy, reflecting changes in the near-world of renal replacement therapies, and the wider-world of nutrition.  While the support and cooperation between nephrologists, nutritionists and dieticians is the winning (gold- standard) solution in developed countries, it is important to remember that dietary treatment of CKD was an important skill for a nephrologist to have, and that regaining this expertise may be the best strategy for low-income countries, in which a lack of resources limits the offer of care.

This special issue focuses on low-protein diets as part of the “medical management” of CKD but is also open to other aspects of the clinical management of advanced CKD patients.  We have made available, along with regular research and review papers, a series of practical strategies, counsels, and suggestions, as well as examples of dietary schemas given to patients.

This special series has been partially sponsored by Fresenius Kabi.  All contributing authors, reviewers, and editors are fully independent of the sponsor.

Edited by: Dr Giorgina Piccoli, Dr Adamasco Cupisti, Dr Hayley Henderson


  1. Mediterranean diet is characterized by low to moderate consumption of animal protein and high consumption of fruits, vegetables, bread, beans, nuts, seeds and other cereals. It has been associated with reduced...

    Authors: Khawla Kammoun, Hanen Chaker, Hichem Mahfoudh, Nouha Makhlouf, Faical Jarraya and Jamil Hachicha
    Citation: BMC Nephrology 2017 18:34
  2. Correction of metabolic acidosis (MA) with nutritional therapy or bicarbonate administration is widely used in chronic kidney disease (CKD) patients. However, it is unknown whether these interventions reduce i...

    Authors: Antonio Bellasi, Lucia Di Micco, Domenico Santoro, Stefania Marzocco, Emanuele De Simone, Mario Cozzolino, Luca Di Lullo, Pasquale Guastaferro and Biagio Di Iorio
    Citation: BMC Nephrology 2016 17:158
  3. Low-protein diets (LPD) are an important means of delaying the need for dialysis and attaining a stable metabolic balance in chronic kidney disease (CKD). Many authors consider a low educational level and illi...

    Authors: Stefania Maxia, Valentina Loi, Irene Capizzi, Giorgina Barbara Piccoli, Gianfranca Cabiddu and Antonello Pani
    Citation: BMC Nephrology 2016 17:138
  4. Pregnancy in women with advanced CKD becoming increasingly common. However, experience with low-protein diets in CKD patients in pregnancy is still limited.

    Authors: Rossella Attini, Filomena Leone, Silvia Parisi, Federica Fassio, Irene Capizzi, Valentina Loi, Loredana Colla, Maura Rossetti, Martina Gerbino, Stefania Maxia, Maria Grazia Alemanno, Fosca Minelli, Ettore Piccoli, Elisabetta Versino, Marilisa Biolcati, Paolo Avagnina…
    Citation: BMC Nephrology 2016 17:132
  5. Native arteriovenous fistula (AVF) is the most appropriate type of vascular access for chronic dialysis. Its patency rates depend on vascular wall characteristics. Ketoacid analogues of essential amino acids (...

    Authors: Cristiana David, Ileana Peride, Andrei Niculae, Alexandra Maria Constantin and Ionel Alexandru Checherita
    Citation: BMC Nephrology 2016 17:131
  6. Nutrition has been an important part of medical management in patients with chronic kidney disease for more than a century. Since the 1970s, due to technological advances in renal replacement therapy (RRT) suc...

    Authors: Maria Chan
    Citation: BMC Nephrology 2016 17:129
  7. Cameroon is a low–middle income country with a rich diversity of culture and cuisine. Chronic kidney disease (CKD) is common in Cameroon and over 80 % of patients present late for care, precluding the use of t...

    Authors: Gloria Enow Ashuntantang, Hermine Fouda, Francois Folefack Kaze, Marie-Patrice Halle, Crista Tabi-Arrey and Magloire Biwole-Sida
    Citation: BMC Nephrology 2016 17:126
  8. Dietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially i...

    Authors: Adamasco Cupisti, Claudia D’Alessandro, Biagio Di Iorio, Anna Bottai, Claudia Zullo, Domenico Giannese, Massimiliano Barsotti and Maria Francesca Egidi
    Citation: BMC Nephrology 2016 17:124
  9. Chronic kidney disease (CKD) is an emerging health public problem in Brazil. Nutritional counseling with focus on protein restriction is a promising strategy to treatment of nondialysis CKD patients due its ef...

    Authors: Denise Mafra and Viviane O. Leal
    Citation: BMC Nephrology 2016 17:105
  10. Evidence exists that nutritional therapy induces favorable metabolic changes, prevents signs and symptoms of renal insufficiency, and is able to delay the need of dialysis. Currently, the main concern of the r...

    Authors: Claudia D’Alessandro, Giorgina Barbara Piccoli, Patrizia Calella, Giuliano Brunori, Franca Pasticci, Maria Francesca Egidi, Irene Capizzi, Vincenzo Bellizzi and Adamasco Cupisti
    Citation: BMC Nephrology 2016 17:102
  11. Whereas in many parts of the world a low protein diet (LPD, 0.6-0.8 g/kg/day) is routinely prescribed for the management of patients with non-dialysis-dependent chronic kidney disease (CKD), this practice is i...

    Authors: Kamyar Kalantar-Zadeh, Linda W. Moore, Amanda R. Tortorici, Jason A. Chou, David E. St-Jules, Arianna Aoun, Vanessa Rojas-Bautista, Annelle K. Tschida, Connie M. Rhee, Anuja A. Shah, Susan Crowley, Joseph A. Vassalotti and Csaba P. Kovesdy
    Citation: BMC Nephrology 2016 17:90
  12. This review provides an overview of the development, implementation and practise of low protein diets (LPD) in Sweden. While the current practice is discussed in general terms emphasizing the interplay between...

    Authors: Sintra Eyre, Gerd Faxén-Irving, Per-Ola Attman, Marie Evans, Karin Windahl, Sigrid Wegener, Charlotte Andersén, Karin Nykvist-Raanaes, Sara Einemo and Juan-Jesus Carrero
    Citation: BMC Nephrology 2016 17:89
  13. This paper describes the 30-year experience on nutritional management of non-dialysis dependent chronic kidney disease (CKD) patients in a public outpatient clinic located in the city of São Paulo, Brazil. A t...

    Authors: Lilian Cuppari, Fabiana Baggio Nerbass, Carla Maria Avesani and Maria Ayako Kamimura
    Citation: BMC Nephrology 2016 17:85
  14. Nutritional treatment has always represented a major feature of CKD management. Over the decades, the use of nutritional treatment in CKD patients has been marked by several goals. The first of these include t...

    Authors: Vincenzo Bellizzi, Adamasco Cupisti, Francesco Locatelli, Piergiorgio Bolasco, Giuliano Brunori, Giovanni Cancarini, Stefania Caria, Luca De Nicola, Biagio R. Di Iorio, Lucia Di Micco, Enrico Fiaccadori, Giacomo Garibotto, Marcora Mandreoli, Roberto Minutolo, Lamberto Oldrizzi, Giorgina B. Piccoli…
    Citation: BMC Nephrology 2016 17:77
  15. Dietary therapy represents an important tool in the management of chronic kidney disease (CKD), mainly through a balanced reduction of protein intake aimed at giving the remnant nephrons in damaged kidneys a “...

    Authors: Giorgina Barbara Piccoli, Irene Capizzi, Federica Neve Vigotti, Filomena Leone, Claudia D’Alessandro, Domenica Giuffrida, Marta Nazha, Simona Roggero, Nicoletta Colombi, Giuseppe Mauro, Natascia Castelluccia, Adamasco Cupisti and Paolo Avagnina
    Citation: BMC Nephrology 2016 17:76
  16. The multi-racial and multi-ethnic population of South Africa has significant variation in their nutritional habits with many black South Africans undergoing a nutritional transition to Western type diets. In t...

    Authors: Oluwatoyin I. Ameh, Lynette Cilliers and Ikechi G. Okpechi
    Citation: BMC Nephrology 2016 17:68
  17. Low protein diets (LPD) have long been prescribed to chronic kidney disease patients with the goals of improving metabolic abnormalities and postpone the start of maintenance dialysis.

    Authors: Denis Fouque, Jing Chen, Wei Chen, Liliana Garneata, SJ Hwang, Kamyar Kalantar-Zadeh, Joel D. Kopple, William E. Mitch, Giorgina Piccoli, Vladimir Teplan and Philippe Chauveau
    Citation: BMC Nephrology 2016 17:63
  18. Renal replacement therapy (RRT) is growing by 10 % per year in Russia, but pre-dialysis care which can retard CKD progression and delay the start of RRT remains limited. We evaluate the effect of Essential Ami...

    Authors: Alexander Zemchenkov and Irina N. Konakova
    Citation: BMC Nephrology 2016 17:62