Proteinuria as a marker of CKD Severity (Stage 3 orc4 before Renal Replacement Therapi)

The role of proteinuria in the progression to kidney failuire has been well established, and the severity of renal disease is positively correlated with the level of proteinuria. More recenly, several studies have shown that proteinuria is also one of the most important and independent factor of cardiovascular morbidity and mortality.

A lowering effect of proteinuria by 58% due to adherence to marked protein-restricted diet has been reported by Di Iorio et al. A proaspective, randomized, controled, crosover trial evaluated the terapetic efficacy of a keto/amino acid supplemented VLPD in comparison with an LPD in a group[ ohf CKD patient (stage 4 or 5) exhibiting a persistent proteinuria higher than 3 g/day. This study demonstrated that a keto/amino acid supplemented VLPD reduce both proteinuria and serum advanced glycation end product- even in the presence of complete inhibition of the renin-angiotensin system in patien with moderate to advanced CKDand severe proteinurtia.

A study by Chang at al. investigated whether keto/amino acid suplementatioan during an LPD retards progession of CKD and maintain nutritional status in nutritionally well-trained CKD patyients.A group of 120 diabetic and nondiabetic CKD (stage 3 or 4) patients were assignedto asn LPD alone or to a Ketosteril -supplemented LPD for  6 months. The author showed that keto/amino acid supplementation in additional to LPDs delyaed the progression of CKD without deteriorating nutritiopnal status, and patiens with diabetees or those with a better nutritional status showed a greater likelihood of beneffiting from the diet.

Even if dialisis is a well-established life-saving therapy, it is associated with a high economic burden and clinically severe complication-especially in elderli patients (age>70 year). additionally, health and economic benefit could derive from postponing dialysis treatment by the implementation of a VLPD supplemented with keto/ amino acids (sVLPD). A randomized controlled clinical trial performed by Brunori et al. has shown that elderly  stage 5 CKD patients on sVLPDs were able to delay the initiation of dialysis for 1 year, on average, with no negative consequence with respect to morbidity an mortality. By using this data, a recent analysis aimed to estimetae and compare cost and benefits of dialysis versus sVLPD treatmentfrom the perspective of the italian National health Service in elderly patients effected by stage 5 CKD. data of 57 patients with non diabetic CKD (gromelural filtration rate: 5 to 7 mL/mnt/1.73m2) were analyzed with respect to costs for dialysis treatment and hospitalization by using the diagnosis-related group tariffts 9e.g vascular/peritoneal acces/complications), drugs, laboratory/instrumental tests,medical visitsand cost of patientn's travel for a period of 3.2 year. The opportunity to safely postpone initiation of dialysis of 1 year/patient, on average, translated into an economic benefit to the National Health Service, corresponding to 21,180$/patient in the first, 6,500$/patient in the second and 683$/patient in the third year of treatmen