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The perils of Salt
Dialysis finally forced recognition of its importance in kidney disease The Amazonian Yanomami Indians famously manage on only 50mg (1 mmol) of sodium chloride per day, while in more developed societies we struggle to keep our average intake below 100 times that level. Humans probably mostly evolved on diets more like that of the Yanomami.…
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Surprises from the 1994 Modification of Diet in Renal Disease (MDRD) study
Low-protein disappoints; attention drawn to proteinuria and blood pressure The MDRD study was a landmark trial set up to prove the importance of dietary protein in slowing the progression of kidney failure. This had been shown in animal models but human studies were not so clear. It was combined with using two different blood pressure…
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Diets for chronic uraemia
1949-1993: Addis to Giovannetti It didn’t work for her: a 46 year old female patient who stopped her diet. Note that it was lowering urea but not creatinine. From Shaw et al 1965, by kind permission of OUP. Low protein diets were shown to prolong the life of uraemic rats in experiments in the 1930s,…
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Diet for acute renal failure in the 1940s
The beginning of the multidisciplinary renal team In 1949 Thomas Addis described the anarchy that existed in recommendations for the management of acute glomerulonephritis. He argued for protein restriction, as was becoming accepted for chronic uraemia, but it was in acute renal failure (ARF, or AKI) that real progress was being made. An Edinburgh diet…