Andreana De Mauri1, Deborah Carrera2, Matteo Vidali3, Marco Bagnati4, Roberta Rolla4,5, Sergio Riso2, Massimo Torreggiani6, Doriana Chiarinotti1. 1. Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy. 2. Nutritional Science and Dietetic, Maggiore della Carità University Hospital, 28100 Novara, Italy. 3. Clinical Chemistry Unit, Fondazione IRCCS Ca' Granda Maggiore Policlinico Hospital, 20122 Milano, Italy. 4. Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy. 5. Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, 28100 Novara, Italy. 6. Néphrologie et Dialyse, Centre Hospitalier Le Mans, 72037 Le Mans, France.
Abstract
BACKGROUND: In medicine, "compliance" indicates that the patient complies with the prescriber's recommendations, "adherence" means that "the patient matches the recommendations" and "concordance" means "therapeutic alliance" between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. PATIENTS: Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A2 (Lp-PLA2) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. RESULTS: nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA2, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. CONCLUSION: This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in "adherent" and "concordant" patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions.
BACKGROUND: In medicine, "compliance" indicates that the patient complies with the prescriber's recommendations, "adherence" means that "the patient matches the recommendations" and "concordance" means "therapeutic alliance" between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. PATIENTS: Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A2 (Lp-PLA2) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. RESULTS: nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA2, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. CONCLUSION: This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in "adherent" and "concordant" patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions.
Authors: Ana Paula Black; Juliana S Anjos; Ludmila Cardozo; Flávia L Carmo; Carla J Dolenga; Lia S Nakao; Dennis de Carvalho Ferreira; Alexandre Rosado; José Carlos Carraro Eduardo; Denise Mafra Journal: J Ren Nutr Date: 2018-02-10 Impact factor: 3.655
Authors: Michael H Davidson; Marshall A Corson; Mark J Alberts; Jeffrey L Anderson; Philip B Gorelick; Peter H Jones; Amir Lerman; Joseph P McConnell; Howard S Weintraub Journal: Am J Cardiol Date: 2008-06-16 Impact factor: 2.778