Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet.
Study Goal
The researchers aimed to evaluate the impact of a low-protein diet (LPD) on traditional uremic and atherogenic toxins in advanced CKD patients, focusing on compliance, adherence, and concordance.
Results Summary
The study found that LPD significantly reduced nPCR, blood urea nitrogen, cholesterol, and triglycerides. Adherent and concordant patients showed decreased levels of t-PCS, t-IS, and Lp-PLA2, while non-concordant patients experienced increases in these markers.
Population
Fifty-seven adult patients with advanced chronic kidney disease (CKD).
Effective Dosage
Not specified
Duration
Two months
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
low protein diet (LPD) | decrease | normalized protein catabolic rate (nPCR) | advanced CKD adult patients | - | significantly decreased | #1 |
low protein diet (LPD) | decrease | blood urea nitrogen | advanced CKD adult patients | - | significantly decreased | #2 |
low protein diet (LPD) | decrease | cholesterol | advanced CKD adult patients | - | significantly decreased | #3 |
low protein diet (LPD) | decrease | triglycerides | advanced CKD adult patients | - | significantly decreased | #4 |
low protein diet (LPD) | decrease | total p-Cresyl Sulphate (t-PCS) | adherent subjects | - | decreased | #5 |
low protein diet (LPD) | decrease | total Indoxyl Sulphate (t-IS) | adherent subjects | - | decreased | #6 |
low protein diet (LPD) | decrease | Lipoprotein-associated phospholipase A2 (Lp-PLA2) | concordant subjects | - | decreased | #7 |
low protein diet (LPD) | decrease | total p-Cresyl Sulphate (t-PCS) | concordant subjects | - | decreased | #8 |
low protein diet (LPD) | decrease | free-PCS | concordant subjects | - | decreased | #9 |
low protein diet (LPD) | decrease | total Indoxyl Sulphate (t-IS) | concordant subjects | - | decreased | #10 |
low protein diet (LPD) | increase | Lipoprotein-associated phospholipase A2 (Lp-PLA2) | non-concordant subjects | - | increased | #11 |
low protein diet (LPD) | increase | total p-Cresyl Sulphate (t-PCS) | non-concordant subjects | - | increased | #12 |
low protein diet (LPD) | increase | free-PCS | non-concordant subjects | - | increased | #13 |
low protein diet (LPD) | increase | total Indoxyl Sulphate (t-IS) | non-concordant subjects | - | increased | #14 |
low protein diet (LPD) | decrease | traditional uremic toxins and atherogenic toxins | "adherent" and "concordant" patients | - | may improve the control of | #15 |
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.