Table 2 The “LPD menu”: some reflections on compliance

“Traditional”

0.6–0.8 g/Kg/day; mixed proteins

Modulated upon quantity of usual food; in moderate and hot climates, traditional cuisine is more plant based, and returning to the roots may be useful

Mediterranean- Asian origin; careful with preparation, cook their own food

A very natural approach, adapted to all settings, doesn’t require special food,

Demanding: requires special attention to quantity and quality of food

Large room for personalization, discovery and rediscovery of traditional cuisine; flexible; Educational approach is needed.

Vegan

0.6–0.8 g/Kg/day; vegetable proteins

Unrestricted vegan diets are usually in the 0.7–0.9 g/Kg/day protein intake range; due to the different bioavailability, a 0.7 diet roughly corresponds to a 0.6 mixed protein diet

“New age”, young people who want to avoid supplements or special food; Cook their own food

A “trendy” approach, due to the diffusion of veganism in the western world; a natural diet that may have other favourable effects on health

Demanding: requires special attention to quality of food and to the integration of legumes and cereals. Risk of B12, vit D and iron deficits

Quite good room for personalization, especially for not becoming boring; relatively flexible; Educational approach is needed.

Vegan supplemented

0.6 g/Kg/day; vegetable proteins, supplemented with a mixture of amino- and keto-acids

Based upon forbidden (animal origin) and allowed (all other) food. Animal-derived food is allowed only in “free meals”

young working people, who want a simple diet, easily adapted to any situation

A simplified approach: supplements avoid the need to integrate legumes and cereals, thus reducing the risk of nutritional deficits

Adding pills to the usual, often already demanding drug list.

Expensive where supplements are not supplied by the health care system

Some room for personalization, especially for not becoming boring; relatively flexible; Educational approach has to be combined with a prescription approach (supplements)

Protein-free food

0.6 g/Kg/day; mixed proteins

Protein-free pasta, bread and other carbohydrates

Mediterranean- Asian origin; elderly people who do not want to change their habits

May allow a reduction of proteins without changing eating habits

The protein-free food tastes different and may not be “tasty”, it is expensive where foods are not supplied by the health care system. The food has to be prepared separately

Large room for personalization, may preserve previous habits in Mediterranean settings; relatively flexible; Prescription approach for protein-free food.

Very low-protein supplemented (with or without protein-free food)

0.3 g/Kg/day; vegetable proteins, supplemented with a mixture of amino- and keto-acids; higher dose as with the 0.6 diet

Based upon forbidden (animal origin) and allowed (all other) food. Animal-derived food is allowed only in “free meals” (usually no more than 1 per week)

Highly motivated patients who do not want to start dialysis or are waiting for transplantation

The most effective approach for delaying dialysis start

Adding many pills to the usual, often already demanding drug list. Very difficult if protein- free food is not available.

Expensive where supplements and protein-free foods are not supplied by the health care system

Scarce room for personalization; not flexible; Educational approach has also to be focused on compliance; has to be combined with a prescription approach (supplements).