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Kidney Week

Abstract: PO1066

Calcium Carbonate-Pre-Added Cheese to Improve Compliance, Nutrition, and Metabolic Balance of Patients on Renal Replacement Treatment

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ardissino, Gianluigi, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Capone, Valentina, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Margiotta, Elisabetta, Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Cropanese, Isabella, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Raffiotta, Francesca, Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Montini, Giovanni, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Messa, Piergiorgio, Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
Background

Patients with chronic kidney disease have several dietary limitations that make their diet unappealing with detrimental consequences as adherence to prescriptions, malnutrition and overall poor quality of life. Cheese, an important component of the Western diet, has high phosphorus (P) content thus its consumption is generally restricted in patients on renal replacement therapy (RRT).

Methods

A special cheese was prepared by adding a fixed concentration of CaCO3 (5 gr/L) to cow milk prior to production procedures. The cheese was then provided to a cohort of patients on chronic RTT with the working hypothesis that while eating the modified cheese patients would have benefited from the phosphorus-binding effect of CaCO3. After a run-in period of 1 month, all patients were randomly assigned to receive standard cheese (SC) followed by modified cheese (FriP) or the opposite sequence in a double blind and cross-over fashion for 1 month for each product. The increase in inter-dialysis (48 hrs) P (DP) was regularly and repeatedly (n: 5) measured during each of the 2 periods. A washout period of 1 week was introduced between treatment periods.

Results

Twenty-one patients were enrolled and 16 successfully completed the 2 treatment periods. Drop outs were due to transplantation, COVID-19 infection or to documented non-adherence to the protocol. Observed mean (sd) DP were as follows: Run-in: 2.8 (0.7) mg/dL, SC: 2.8 (0.85) mg/dL, FriP 2.4 (0.61) mg/dL with the latter being significantly lower compared with both other periods. Pre-dialysis P was also lower with FriP compared with SC: 5.00 (1.00) vs 4.66 (0.91) while Pre-dialysis Ca was not diffent: 9.24 (0.73) vs 9.24 (0.63) with SC and FriP, respectively. All patients appreciated both products equally and the mean amount consumed per week was not different: SC: 307 gr vs FriP: 283 gr (p: 0.56). All patients reported a significant gratification by reintroducing cheese consumption in their diet.

Conclusion

In conclusion, FriP cheese may reduce dietary limitations of patients on RRT mith significant benefits on: malnutrition, adherence to P binders prescription and ultimately to quality of life.