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. 2020 Nov 12;9(11):3644. doi: 10.3390/jcm9113644

Table 3.

Low protein diets as a medication.

A. Types and Dosages of Low Protein Diet
  • -

    Conventional LPD, supplying 0.55 to 0.60 g/kg b.w./day of mixed proteins, at least 50% of high biological value.

  • -

    Vegan LPD, supplying 0.6–0.7 g/kg b.w./day of plant origin proteins using a special combination of cereal and legumes, and/or soy.

  • -

    Very low protein diet to patients with CKD and without diabetes: 0.28 to 0.43 g/kg b.w./day with additional keto acid/amino acids to meet protein requirement of 0.55 to 0.60 g/kg b.w./day, usually 1 tablet every 5 kg b.w.

  • -

    Mostly vegetarian diets supplying 0.7–0.8 g/kg b.w.d of unselected proteins, supplemented or not with essential amino acids and ketoacids (usually 1 tablet every 10 kg b.w).

B. Mechanisms of Action of Low Protein Diet
  • -

    Reduced production of protein-derived waste products

  • -

    Reduced retention of protein-derived toxins and fixed acids

  • -

    Reduced phosphate load, with lesser stimulation of parathyroid hormone production

  • -

    Reduced single-nephron glomerular hyperfiltration

  • -

    Reduced urine protein excretion

C. Indications to a Low-Protein Diet
  • -

    Prevention and treatment of metabolic and electrolyte abnormalities, signs and symptoms of chronic renal insufficiency

  • -

    Prevention of protein-energy wasting

  • -

    Delay the start of renal replacement therapy

  • -

    Management of proteinuria, hypertension, or progressing chronic kidney disease

D. Contraindications to a Low-Protein Diet
Absolute
  • -

    Protein energy wasting

  • -

    Hypercatabolic state (acute or chronic)

  • -

    Anorexia and eating disorders

  • -

    End of life care management

Relative
  • -

    Poor attitude to dietary modifications

  • -

    Psychiatric / psychological disorders

  • -

    Logistic barriers (economic, cultural, lack of support)

  • -

    Poorly controlled diabetes

  • -

    Chronic steroid treatment

  • -

    Intestinal diseases including chewing disorders

  • -

    Short life-expectancy

E. Unwanted Side Effects of LPD
  • -

    Weight loss due to reduced energy intake

  • -

    Loss of muscle mass due to inadequate protein and energy intake

  • -

    Depression, relational problems, psychological discomfort

F. Possible Supplementations during Low Protein Regimens
  • -

    Calcium

  • -

    Vitamins

  • -

    Iron

  • -

    Essential amino acids and ketoacids

G. Special Conditions
  • -

    Nephrotic syndrome

  • -

    Diabetes

  • -

    Obesity

  • -

    Pregnancy

  • -

    Very old, aged patient

  • -

    Neuromuscular disorders

  • -

    Short life expectancy