Low-protein diet: delays the start of dialysis, improves survival and generates savings for public health
Given that more than 7,000 patients start dialysis in Italy every year, if this therapy were applied systematically to all patients, it could save the National Health Service around 60 million euros a year, but a customised nutritional programme, professional support and patient adherence to the prescription are needed
by Vincenzo Bellizzi *
Chronic Kidney Disease (CKD) is among the chronic diseases with the highest clinical and social impact, with an increasing number of patients starting dialysis each year and with mortality increasing in contrast to other chronic diseases where it is decreasing; it has been estimated that by 2040 CKD will be the fifth leading cause of death worldwide. Moreover, the very high costs of Mrc are considered 'catastrophic' as they are not sustainable in many countries, causing millions of deaths that could be avoided. In this scenario, therapies capable of slowing down the progression of the disease play a central role not only for the wellbeing of the individual, but also for the sustainability of healthcare systems: it is not enough for therapies to be effective, they must also be economically sustainable.
The hypoproteic diet
The hypoprotein diet is an essential therapy in Mrc, capable of affecting the clinical course of the disease, and requires careful supervision and continuous counselling of the patient by a multidisciplinary team (nephrologist, dietician) to achieve adequate adherence to the prescription.
A recent Italian study, published in an international scientific journal, analysed the effects of low-protein diets in patients with advanced renal failure. The research showed that a low-protein diet, if followed with good adherence by patients, can delay dialysis entry by about 20 months and prolong survival by about 2 years. Thus, the hypoprotein diet allows patients to prolong the conservative phase of the disease, preserve a good quality of life for longer, avoid the physical and emotional impact of renal replacement therapy (dialysis), and improve survival. Postponing the start of dialysis, in fact, reduces complications, maintains greater autonomy and reduces access to the healthcare facility.
Costs and possible savings
The study also assessed the costs, direct and indirect (i.e. those borne by the patient), associated with disease management. Hypoproteic diets entail higher monthly costs in the pre-dialytic phase, mainly for aproteic products, nutritional supplements and dedicated clinical controls. In fact, the total monthly costs of nutritional therapy range from €500 to €800 for the most intensive diet regimes, compared to €380 for those on no diet at all. However, these higher costs are much lower than the extremely high costs of dialysis, which exceed EUR 4,200 per month.
The overall analysis of costs over the entire course of the disease, however, shows that over time the hypoproteic diet saves about 30% compared to patients who do not undergo nutritional treatment, amounting to more than €8,000 per year for each patient. Considering that more than 7,000 patients begin dialysis each year in Italy, if this therapy were applied systemically to all patients with Mrc, it could save the SSN about €60 million per year. This result is mainly related to the postponement of the start of dialysis, but also to the reduction of adverse events related to disease progression.
