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
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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
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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)