Nephrology care continues to progress and recommendations are now focused on delaying as much as possible the need for renal replacement therapy ("intent-to-defer"strategy). Protein restriction is a valuable tool for stabilizing chronic kidney disease (CKD) and retarding the need for renal replacement therapy, but the best diet to be prescribed is still matter of discussion. This study is aimed at identifying implementation strategies for nutritional management of advanced CKD.
All adult patients followed on the unit for advanced CKD, with Kidney disease stage 4-5 or stage 3 with fast progression and without contraindications.
Malnutrition or short life-expectancy
Patients aged less than 18 years old
Pregnant women,
Incapacity to complete the free-consent form,
Parallel
low protein diet
Other interventionPatients will be managed with a restricted protein intake (controlled protein diets with a mean target at 0.6 g / kg / day of protein, according to a choice of dietary approaches, adapted to the situation of each patient).
Adherence to the multiple-choice diet program
Percentage of patients who drop-out of the multiple choice diet program
Kidney survival
The "kidney survival" from the beginning of the diet to the start of renal replacement therapy
Patient survival
The patient survival compared to reference data (from the Réseau Epidemiologie, Information, Néphrologie) and international registers.
Cost of the treatment
Cost of the treatment, including diet, renal replacement therapy and pharmacological interventions.
Patients included in a transplantation program
Percentage of patients without contraindications enrolled on the pre-emptive kidney transplant list.
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