Search

In reviewing the history of dietary management in uremia, it is apparent that significant advances have occured in the past few years. Basic nutritional facts have been synthesized into a significant clinical application. Increasing understanding of amino acid requirements and the possibility of resynthesis of nonessential amino acids from urea nitrogen at the clinical level has resulted in the development of a therapeutic, strictly nutritional, approach to the uremic patient. This new approach is based on more scientific data than was available formerly. Encouraging preliminary results suggest that current concepts of protein nutrition with appropriate development may prove of significant benefit both to uremic patients, not yet in need of chronic dialysis or renal transplantation, and to those for whom these more definitive forms of treatment are not yet available for logistical reasons. The opportunity for nutritionists and nephrologists to combine their skills in this area should result in a fruitful application of “clinical nutrition” in its truest sense.

A controlled comparison was made between 17 patients prescribed a high caloric 20-g protein diet (G) of high biological value and 15 patients fed a more conventional isocaloric 40-g mixed protein diet (P). Although the degree of azotemia decreased significantly only with the Gdiet, symptomatic and biochemical improvement was similar in both groups. Weight decreased more frequently and bleeding time increased significantly with the Gdiet. Plasma pH, creatinine clearances, hematocrits, and nerve conduction velocities deteriorated significantly with both diets. Conformity with the diet was evaluated by dietary interviews and analyses of home-prepared diets. While Ppatients usually adhered to the diet, only 1/17 Gpatients followed the diet closely for more than a few weeks. Most remained within 30 g of protein; others deviated more. Even those taking greater than 30 g of protein complained; dissatisfaction and overt hostility were common. Enhanced patient acceptance, greater eating pleasure, and similar symptomatic improvement occurred with the more liberal protein intake.