Effect of a Very Low-Protein Diet on Long-term Outcomes

The poor results reported by Menon et al1 for the long-term outcome on renal replacement therapy (RRT) of patients who had previously received a supplemented very low-protein diet (SVLPD) prompted us to appraise the results of our own series (inclusion period, 1985 to 2000), in which 203 patients followed an SVLPD for more than 3 months (median, 24 months). Patients were followed up monthly by the same physician and same dietitian until the initiation of RRT. Patients started RRT with a mature vascular access, adequate blood pressure control, and satisfactory nutritional status, as previously published.2 We evaluated the long-term outcome of these patients until October 2008 (median time, 145 months). During this time, 102 patients initiated dialysis therapy and 101 received grafts (Table 1). When we compare our data with the French dialysis registry and with 865 patients under the care of the same group who received transplants during the same period, but did not follow the SVLPD, survival analyses were similar. Regular nephrological care in patients with chronic kidney disease is associated with better long-term survival. In the series reported by Menon et al,1 no information is provided about patient care during the period from the end of the Modification of Diet in Renal Disease Study until examination of the US Renal Data System database. This contrasts with the unbroken follow-up of our patients until the initiation of dialysis therapy. It is hardly acceptable to attribute a greater mortality risk to a given therapeutic intervention 7 years after the termination of the clinical trial without being able to identify the most known confounding factors of mortality.

Table 1. Long-term Outcomes of 203 Patients With Chronic Kidney Disease Who Followed an SVLPD

		Initiated Dialysis Therapy (n = 102)	Received Transplant (n = 101)
	Age (y)	60±11	40±12
	SVLPD duration (mo)	31±23	33±32
	Follow-up (mo)	89±62	173±60
	Survival rate
	1 y (%)	97	99
	5 y (%)	60	97
	10 y (%)	33	93

Abbreviation: SVLPD, supplement very low-protein diet.