Low-Protein Vegetarian Diet with Alpha-Chetoanalogues Prior to Pre-emptive Pancreas-Kidney Transplantation

Article View

Abstract
The Review of Diabetic Studies,2004,1,2,95-102.
Published:August 2004
Type:Case Report
Authors:
Author(s) affiliations:

Giorgina B. Piccoli1, Daria Motta1, Guido Martina1, Valentina Consiglio1, Massimo Gai1, Elisabetta Mezza1, Emanuela Maddalena1, Manuel Burdese1, Loredana Colla1, Fabio Tattoli1, Patrizia Anania1, Maura Rossetti1, Giorgio Soragna1, Giorgio Grassi2, Franco Dani2, Alberto Jeantet1, Giuseppe P. Segoloni1

1Chair of Nephrology, Department of Internal Medicine, University of Turin, Corso Dogliotti 16, 10126 Torino, Italy.

2U.O.A. of Diabetology, Department of Internal Medicine University of Turin, Corso Dogliotti 16, 10126 Torino, Italy.

Abstract:

Background: Pre-emptive pancreas-kidney transplantation is increasingly considered the best therapy for irreversible chronic kidney disease (CKD) in type 1 diabetics. However, the best approach in the wait for transplantation has not yet been defined. AIM: To evaluate our experience with a low-protein (0.6 g/kg/day) vegetarian diet supplemented with alpha-chetoanalogues in type 1 diabetic patients in the wait for pancreas-kidney transplantation. Methods: Prospective study. Information on the progression of renal disease, compliance, metabolic control, reasons for choice and for drop-out were recorded prospectively; the data for the subset of patients who underwent the diet while awaiting a pancreas-kidney graft are analysed in this report. Results: From November 1998 to April 2004, 9 type 1 diabetic patients, wait-listed or performing tests for waitlisting for pancreas-kidney transplantation, started the diet. All of them were followed by nephrologists and diabetologists, in the context of integrated care. There were 4 males and 5 females; median age 38 years (range 27.9-45.5); median diabetes duration 23.8 years (range 16.6-33.1), 8/9 with widespread organ damage; median creatinine at the start of the diet: 3.2 mg/dl (1.2-7.2); 4 patients followed the diet to transplantation, 2 are presently on the diet, 2 dropped out and started dialysis after a few months, 1 started dialysis (rescue treatment). The nutritional status remained stable, glycemia control improved in 4 patients in the short term and in 2 in the long term, no hyperkalemia, acidosis or other relevant side effect was recorded. Proteinuria decreased in 5 cases, in 3 from the nephrotic range. Albumin levels remained stable; the progression rate was a loss of 0.47 ml/min of creatinine clearance per month (ranging from an increase of 0.06 to a decrease of 2.4 ml/min) during the diet period (estimated by the Cockroft-Gault formula). Conclusion: Low-protein supplemented vegetarian diets may be a useful tool to slow CKD progression whilst awaiting pancreas-kidney transplantation.