quick thread on the low protein debate at #ISNWCN as you will see, my arguments were more rhetorical rather than showing graphs and stuff Check out @kidney_boy for more on the science 1/

we started with some levity on the wonderful food we get to eat versus unappetizing Kale (from @ChristosArgyrop ) and the huge gap in our respective expertise on the topic - my expertise is being a middle author on this piece in @ASNKidney360 #ISNWCN

Famous scientists have laid the ground for low protein diet Thomas Addis Carmel Giordano (low protein diet was known as the Giordano-Giovannetti diet) Barry Brenner But we need human RCT data - not expert opinions and rat experiments #ISNWCN

RCT data compressed into one table Key aspeccts - RCTs do not report decrease in dialysis - or lower GFR decline - Diets were poorly tolerated (even in their carefully done RCTs!) Be careful with creatinine changes from low protein diet (hence MDRD had nuclear GFR) #ISNWCN

Next 4 slides via @kidney_boy Diet effect is questionable How about drugs? RASi and Flozins act on the same mechanism (Brenner Hyperfiltration hypothesis) #ISNWCN

Protein restriction is an old and tired concept For more on this story see this thread which encapsualtes everything that's wrong about a low protein diet #ISNWCN

These were the finishing talking points for the main part of the debate #ISNWCN

In rebuttal, we discussed access and cost - See data from @valerie_luyckx and team - we really need to work on making flozins (and other upcoming Rx) affordable and accessible globally! - Keto analogs are extremely $$$ too! #ISNWCN

Some discussion about the perceived 'weaknesses' of MDRD (see @kidney_boy slides for longer discussion) And @goKDIGO definitely got it right here versus @NKF KDOQI #ISNWCN

with some more closing rebuttal points and fun quotes If you push low protein diet and follow serum creatinine, you are fooling yourself, and your patients Just be a #Flozinator instead #ISNWCN