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• W2007131518 abstract "To the Editor: Based on data gained in a large cohort of patients on regular predialysis nephrologic care, the proportion of subjects with hemoglobin (Hb) level <11 g/dL, at a creatinine clearance level ≤20 mL/min/1.73 m2, may be estimated at 60% [1.Jungers P.Y. Robino C. Choukroun G. et al.Incidence of anemia and use of epoetin therapy in pre-dialysis patients: A prospective study in 403 patients.Nephrol Dial Transplant. 2002; 17: 1621-1627Crossref PubMed Scopus (31) Google Scholar]. Accordingly, two thirds of predialysis patients should require erythropoietin (EPO) treatment. The high cost of such therapy, however, remains a major limiting factor for its larger use. We monitored EPO requirement in a group of patients with advanced chronic renal failure (CRF) (creatinine clearance ≤25 mL/min) across a two-year time period [2.Di Iorio B.R. Minutolo R. De Nicola L. et al.Supplemented very low-protein diet ameliorates responsiveness to erythropoietin in chronic renal failure.Kidney Int. 2003; 64: 1822-1828Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar]. At the start, patients were divided in a group treated with very low-protein diet (VLPD, N = 10) (0.3 g/kg body wt/day of protein of vegetable origin) supplemented by ketoanalogs and essential amino acids (Alfa Kappa, Kedrion, Lucca, Italy administered at the dose of 1 tablet/5 kg body wt/day) and another group on usual low-protein diet (LPD, N = 10) (0.6 g of protein/kg body wt/day) groups did not differ in caloric intake (35 kcal/kg body wt/day), gender, age, body mass index, renal disease, systolic and diastolic blood pressure, and creatinine clearance. Hb levels were maintained within the target values in all patients during the study period (VLPD, Hb = 11.5 ± 0.2 g/dL; LPD, Hb = 11.5 ± 0.3 g/dL, P = NS). The main result of the study was that the effective decrease of dietary protein intake by 0.3 g/kg body wt/day allowed a reduction of about 35% of the EPO dose required to maintain the target Hb level in advanced CRF. In addition, the decline of renal function was reduced in VLPD (0.01 ± 0.22 mL/min/month) with respect to LPD (-0.30 ± 0.16 mL/min/month, P < 0.003). As a consequence, during the 24 months of follow-up, 2 VLPD patients and 7 LPD patients started chronic dialysis treatment. We have now calculated the costs of therapy provided in the two groups during the 2 years of observation (Table 1). VLPD allowed a saving of economic resources that can be quantified in almost €52,000 (cost in Euros) for 10 patients during the study, which is a mean of €2,600/pt/year for each patient with advanced CRF starting a supplemented VLPD for the sole cost of therapy during two years of treatment. These data remain to be better defined in a larger population; however, it is reasonable to suggest that prescription of supplemented VLPD not only leads to amelioration of the main CRF-related metabolic disturbances, but also allows a significant saving of economic resources.Table 1Cost analysis of two years of treatment in CRF patients kept at either very low-protein diet (VLPD) or low-protein diet (LPD)VLPD (N = 10)LPD (N = 10)DifferenceHypoproteic food51104600510Alfa-kappa54,987054,987Phospate binders6502184−1534Erythropoietin68,081109,196−41,115Iron1642791851Dialysis16,52781,97265,445Total146,997198,74351,746Data are in euros. Open table in a new tab Data are in euros." @default.
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• W2007131518 date "2004-02-01" @default.
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• W2007131518 title "Supplemented very low-protein diet in advanced CRF: Is it money saving?" @default.
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• W2007131518 doi "https://doi.org/10.1111/j.1523-1755.2004.404_2.x" @default.
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