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Nephrology care continues to progress and recommendations are now focused on delaying as much as possible the need for renal replacement therapy ("intent-to-defer"strategy). Protein restriction is a valuable tool for stabilizing chronic kidney disease (CKD) and retarding the need for renal replacement therapy, but the best diet to be prescribed is still matter of discussion. This study is aimed at identifying implementation strategies for nutritional management of advanced CKD.
The recent paradigm on dialysis start suggests that an intention to defer policy should be preferred to beginning dialysis early ("the earliest the best" strategy). This strategy is further supported by the consideration that patient profiles are changing with the increasing proportion of older and higher comorbidity patients. In high comorbidity patients, survival is not necessarily improved by dialysis.
Nutritional care, adapted to each patient's needs and preferences, could in part answer these demands. Indeed, renal function has a strict correlation with dietary patterns. Low protein diets may have two favourable effects: 1) slowing down kidney function decline and 2) delaying the need of replacement therapy (metabolic stabilizing). In dialysis, the nutritional state is the most important survival indicator, and nutritional follow-up should allow starting dialysis in a good nutritional status.
The study proposed here is an implementation study with a principal aim to improve the use of low protein diets in the clinical setting, by offering a multiple choice approach and by adapting the diets to the patients' needs.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Diet group | Experimental | Diet follow-up to personalize a low-protein diet for each patient. All patients following a low protein diet one month or more compose the "diet group". |
|
| Control group | No Intervention | Patients who accepted to take part of the study but refused the low protein diet and patients who discontinued the diet on the first month compose the control group. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| low protein diet | Other | Patients will be managed with a restricted protein intake (controlled protein diets with a mean target at 0.6 g / kg / day of protein, according to a choice of dietary approaches, adapted to the situation of each patient). |
| Measure | Description | Time Frame |
|---|---|---|
| Adherence to the multiple-choice diet program | Percentage of patients who drop-out of the multiple choice diet program | 4 years |
| Measure | Description | Time Frame |
|---|---|---|
| Kidney survival | The "kidney survival" from the beginning of the diet to the start of renal replacement therapy | 4 years |
| Patient survival | The patient survival compared to reference data (from the Réseau Epidemiologie, Information, Néphrologie) and international registers. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Christelle Jadeau, PD | Contact | 0 (33) 2 43 43 43 43 | 37 482 | cjadeau@ch-lemans.fr |
| Name | Affiliation | Role |
|---|---|---|
| Giorgina Piccoli, MD | Centre Hospitalier le Mans | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Pôle Santé Sarthe et Loir | Recruiting | La Flèche | 72200 | France |
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| ID | Term |
|---|---|
| D051436 | Renal Insufficiency, Chronic |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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| ID | Term |
|---|---|
| D018753 | Diet, Protein-Restricted |
| ID | Term |
|---|---|
| D004035 | Diet Therapy |
| D044623 | Nutrition Therapy |
| D013812 | Therapeutics |
| D004032 | Diet |
| D009747 |
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| 4 years |
| Cost of the treatment | Cost of the treatment, including diet, renal replacement therapy and pharmacological interventions. | 4 years |
| Patients included in a transplantation program | Percentage of patients without contraindications enrolled on the pre-emptive kidney transplant list. | 4 years |
| Patients included in a home dialysis program | Percentage of patients without contraindications who started a home dialysis treatment | 4 years |
| Patients included in an incremental dialysis program. | Percentage of patients without contraindications who started dialysis with an incremental schedule. | 4 years |
| Centre Hospitalier Le Mans | Recruiting | Le Mans | France |
|
| D005261 |
| Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| Nutritional Physiological Phenomena |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |