DO LOW-PROTEIN DIETS CAUSE MALNUTRITION?
Reports that dialysis patients lose weight and can have low serum albumin levels has led to concern that low-protein diets prescribed before beginning dialysis therapy cause malnutrition9. In large part, the proscription of low-protein diets arose from the conclusion that hypoalbuminemia and excessive mortality in hemodialysis patients is due to malnutrition9. This is incorrect. CKD leads to several mechanisms that lower serum albumin and cause loss of lean body mass, and these do not include malnutrition12. In fact, malnutrition refers to abnormalities caused by an inadequate amount of nutrients in the diet, or by an unbalanced diet, and careful examination shows that the major factor associated with hypoalbuminemia in hemodialysis patients is evidence of inflammation; the diet plays a minor role13. More importantly, the MDRD Study revealed that CKD patients treated with low-protein diets had a small but statistically significant increase in serum albumin14. Other investigators studyi
