Diet in chronic kidney disease in a Mediterranean African country

BMC Nephrology, Jan 2017

Background Mediterranean diet is characterized by low to moderate consumption of animal protein and high consumption of fruits, vegetables, bread, beans, nuts, seeds and other cereals. It has been associated with reduced risk of cardiovascular disease. However, it is not suitable for chronic kidney disease because of high potassium intake. Discussion Tunisia is an emerging Mediterranean country with limited resources, a high prevalence of chronic hemodialysis treatment and high dialysis expenditures. In order to limit dialysis cost, primary and secondary prevention of chronic renal disease are of paramount importance. In addition to drugs, secondary prevention includes diet measures (e.g. salt diet, protein diet). The aims of diet practice in chronic kidney disease are to slow chronic renal failure progression and to prevent its complications like hyperphosphatemia and hyperkaliemiae. A few decades ago, a Tunisian diet was exclusively Mediterranean, and protein consumption was not excessive. However, today, protein consumption is more comparable to western countries. Salt consumption is also excessive. Some Tunisian diets still include food with high potassium intake, which are not suitable for patients with chronic kidney disease. Therefore, the role of the dietician is extremely important to help calculate and create a dietary regimen tailored to each of our patients. Summary Advice about diets should be adapted to both the patient and population habits to improve adherence rate. As such, the purpose of this article is to provide our own experience regarding medical nutrition therapy in patients with chronic kidney disease in Tunisia, with some changes in food habits. Prevention is far better than treatment. In this perspective, dietary measures must be at the core of our intervention.

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Diet in chronic kidney disease in a Mediterranean African country

Kammoun et al. BMC Nephrology Diet in chronic kidney disease in a Mediterranean African country Khawla Kammoun 0 1 Hanen Chaker 0 1 Hichem Mahfoudh 0 1 Nouha Makhlouf 1 Faical Jarraya 0 1 Jamil Hachicha 0 1 0 Renal Pathology Unit, UR 12 ES 14 Medecin, University Sfax Tunisia , Sfax , Tunisia 1 Neprology Department Hedi Chaker Hospital , Sfax , Tunisia Background: Mediterranean diet is characterized by low to moderate consumption of animal protein and high consumption of fruits, vegetables, bread, beans, nuts, seeds and other cereals. It has been associated with reduced risk of cardiovascular disease. However, it is not suitable for chronic kidney disease because of high potassium intake. Discussion: Tunisia is an emerging Mediterranean country with limited resources, a high prevalence of chronic hemodialysis treatment and high dialysis expenditures. In order to limit dialysis cost, primary and secondary prevention of chronic renal disease are of paramount importance. In addition to drugs, secondary prevention includes diet measures (e.g. salt diet, protein diet). The aims of diet practice in chronic kidney disease are to slow chronic renal failure progression and to prevent its complications like hyperphosphatemia and hyperkaliemiae. A few decades ago, a Tunisian diet was exclusively Mediterranean, and protein consumption was not excessive. However, today, protein consumption is more comparable to western countries. Salt consumption is also excessive. Some Tunisian diets still include food with high potassium intake, which are not suitable for patients with chronic kidney disease. Therefore, the role of the dietician is extremely important to help calculate and create a dietary regimen tailored to each of our patients. Summary: Advice about diets should be adapted to both the patient and population habits to improve adherence rate. As such, the purpose of this article is to provide our own experience regarding medical nutrition therapy in patients with chronic kidney disease in Tunisia, with some changes in food habits. Prevention is far better than treatment. In this perspective, dietary measures must be at the core of our intervention. Chronic renal failure; Diet; Low protein diet; Phosphorus; Potassium; Sodium - Background Tunisia is an emerging country with limited resources (https://en.wikipedia.org/wiki/Emerging_markets#cite_note-2, https://www.theisn.org/images/Membership/Eli gible_Countries_for_Joint_Membership_Jan_2016.pdf, https://datahelpdesk.worldbank.org/knowledgebase/articles/378834-how-does-the-world-b). Chronic hemodialysis treatment begun in Tunisia in 1963 with a very strict selection. Only young people with social insurance, and without severe co morbidities (like neoplasia or severe heart disease) were treated with dialysis. End stage renal disease incidence rose from 81.6 per million people (pmp) to 137 in 2007 [1, 2]. This sharp increase could be linked to a political decision made in 1991 to treat all patients, regardless of their social insurance and comorbidities, but without significant increased number of renal transplantation which was at 14 pmp in 2007. Prevalence of renal replacement therapy (RRT) in December 2007 was 713 pmp [2]. Sfax is a southern Tunisian city, with one million population. According to the last regional registry data in 2014 RRT prevalence was 771 patients. The main causes of end stage chronic kidney disease are unknown nephropathy [3]. Increase in the prevalence of ESRD treated with dialysis has led to an increase in costs of dialysis treatment, and dialysis expenditures represented 4.5% of Tunisian Health budget in 2000 [1]. Primary and secondary CKD prevention is therefore essential to our country which has limited resources. Primary prevention aims to decrease CKD incidence. Secondary © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. prevention aims to slow renal function decline. They include not only therapeutic measurement such as control of hypertension, diabetes, but also lifestyle and dietary measures such as restricting sodium and protein intake. Protein intake is still low in several Sub-Saharan African countries [4]. In Tunisia, protein intake appears to be adequate and similar to that observed in migrant Tunisian people living in France and local born French people [5]. In our center, we conducted a dietary intake evaluation prospective study of 100 consecutive CKD patients. Mean protein (...truncated)


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Khawla Kammoun, Hanen Chaker, Hichem Mahfoudh, Nouha Makhlouf, Faical Jarraya, Jamil Hachicha. Diet in chronic kidney disease in a Mediterranean African country, BMC Nephrology, 2017, pp. 34, 18, DOI: 10.1186/s12882-017-0448-2