Around the World with Nephrology:An Autobiography

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In this Curiously, while evidence about the advantages of plant-based, Mediterranean diets were accumulating, the world population moved to higher protein intake, which was only recently reduced, also on account of the emerging data on the negative effects of diets particularly rich in red meat and processed food. Only relatively recently have we seen the rediscovery of the Mediterranean diet, poor in red meat and rich in oil rather than animal fats, and of several other plant-based diets and traditional foods, offsetting the trend towards quickly prepared, packaged, unhealthy food [ 2 — 8 ].

The kidney is a faithful mirror of the vascular tree and what is good for the heart is good for the kidneys. The Seven Countries Study takes us back to the aftermath of the second-world-war when, almost paradoxically, cultural exchanges had increased as a result of the war. The desire to share information about the advances in medical knowledge, made during and after the war was widespread.

Meanwhile, the interest in diet and nutrition was modulated by the complex social and cultural changes, most recently merging into the on-going world crisis, globalization, and the aging of the overall population [ 9 — 12 ].


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Nephrology progressed at an incredible speed; dialysis became possible, then widely available in western countries, and increasingly required in aging populations. Fifty years since the beginning of maintenance dialysis treatments, the issue of patient selection for dialysis is being posed again on a global scale.

In low-income countries, the use of well-balanced, low protein diets LPD may serve to prolong survival for a few years in patients who have no access to dialysis: it is a not quite sufficient, albeit not negligible, goal when dialysis is missing. The programs Remuzzi designed to improve the survival of patients with AKI or CKD in developing countries demonstrated that simple, low-cost management approaches could be used to slow the progression of CKD in thousands of individuals [ 14 ].

ISBN 13: 9789814390026

Other papers deal with this important question. The African experience shows that a well-balanced diet, with a restricted protein content, can be proposed in many contexts, including low-income, low-literacy settings [ 15 , 16 ]. Consequently, interest has shifted to the effect of low-protein diets to delaying the progression of CKD, to their potential role as metabolic stabilizers, allowing a longer period of acceptable clinical balance without dialysis, and finally to the feasibility and implementation strategies [ 21 , 22 ]. One consequence of the recent interest in incremental dialysis has been to suggest a role of LPDs in allowing smoother dialysis start and in preserving residual renal function, one of the strongest predictors of outcome [ 23 — 25 ].

Their paper deals with the recent evidence on some complex aspects that often make the findings of studies on low-protein diets difficult to evaluate, among them the extent to which they interact with other aspects of the global care of CKD patients, such as metabolic acidosis or hyperphosphatemia. While the authors focus on high-quality evidence from large trials, they also mention how observational studies also represent important tools for implementation in clinical practice.


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  8. The various experiences here presented convey several different messages, and may also dispel common beliefs associated with low protein diets. Low-protein diets are feasible everywhere: in countries like Italy, in which several alternative options have been developed over time, as well as in Countries such as Japan, India, Brazil, Russia Sweden and Romania, in which fewer options are routinely followed [ 21 — 27 ]. Evidence exists that low-protein diets are safe, provided that they are correctly prescribed, and patients receive regular check-ups to ensure they are following the indications they have been given.

    This is a leitmotif in all the papers, which underline the importance of careful clinical control of on-diet patients, whenever possible by both a nephrologist and a renal dietician or, even better, by a larger work team [ 28 — 41 ]. In countries such as Australia or the US, in which the normal protein intake is well above 1.

    A similar intake may be needed in poorer countries, for balancing malnutrition [ 16 , 32 , 33 ]. The availability of amino acid and ketoacid supplements helps to simplify diet strategies, and their use makes it possible to safely reduce protein intake to 0.


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    6. The European and Asian experiences are remarkably positive, both with low- and very low-protein regimens, even for prolonged periods of time [ 26 , 35 ]. The evidence of the favorable role of moderately restricted vegan supplemented diets on fetal growth is an important element demonstrating the safety of this approach, as long as there is careful multidisciplinary monitoring [ 36 ].

      The Italian experience with protein-free foods is of particular interest. These products, available free of charge only in this country, represent an easy way to increase energy intake without raising the dietary load of nitrogen, phosphate or potassium, which suggests that this interesting option should be made more widely available [ 21 — 24 ].

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      The colorful menus gathered from around the world describe not only feasible, but also wonderful diets with delicious dishes, and show that reducing protein intake need not entail reducing the pleasure of eating well-prepared, tasty food. The final message is therefore for our patients: low-protein diets are effective and safe, but some effort must be made to make them tasty and easy to follow. GBP and AC contributed equally to the drafting of this editorial. Both reviewed and approved the final version.

      Neither author has competing interests regarding this manuscript. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Giorgina B. Piccoli, Email: ti. Adamasco Cupisti, Email: ti. National Center for Biotechnology Information , U. BMC Nephrol. Published online Mar Piccoli 1, 2 and Adamasco Cupisti 3. Author information Article notes Copyright and License information Disclaimer.

      Corresponding author. Received Dec 4; Accepted Mar This article has been cited by other articles in PMC. Associated Data Data Availability Statement not applicable. Abstract In this editorial we present the special issue dedicated to low-protein diets LPDs in chronic kidney disease, from a global perspective.

      An overall view: low-protein diets, and changes in eating habits There have been enormous advances in medicine in the new millennium: dozens of new drugs have come onto the market; new diagnostic approaches have been developed; new genes have been associated with their functions, and the secrets of the human genome are being progressively unraveled. About This Item We aim to show you accurate product information.

      Around the World with Nephrology: An Autobiography - Zbylut J. Twardowski - Google книги

      Manufacturers, suppliers and others provide what you see here, and we have not verified it. See our disclaimer. This is the story of a boy raised up in a village in Poland during World War II, with his father deported to concentration camps throughout the war. Some years after he graduated from medical school, he serendipitously entered the then developing field of dialysis, and he eventually embarked on a career-long practice in the field, where he contributed to the development of a number of new inventions and therapeutic methods.

      The book contains 13 chapters covering the author's childhood, education, and his career-long contributions to the field of nephrology. The book includes inspirational stories of his patients; the struggles he faced in the course of getting his numerous inventions patented; his research work in the s; his work of teaching and consulting; and not the least, his travels to interesting places unrelated to business.

      The book concludes with an epilogue summarizing his life, as well as his predictions regarding treatment of chronic renal failure in the future. Customer Reviews. Write a review. See any care plans, options and policies that may be associated with this product. Email address.

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