Dietary protein restriction in renal insufficiency in private practice.

About 50% of patients in an ambulatory setting with different stages of renal insufficiency are suitable candidates for protein-restricted diets. This is due to contraindications and, more important, noncompliance of patients. The German health insurance system does not reimburse for dietitians' consultations. Institution and execution of any diet as well as controls of patients' adherence are issues of physicians' work. Protein restriction prescribed varies between 60 and 30 g protein/day. As soon as 40 g/day has been reached, supplementation by essential amino acids is started. Metabolic control is confined to evaluations of BUN/creatinine serum concentration and the reciprocal serum creatinine concentration. Patients' general state of well-being and weight are also followed. For more detailed investigations there is also no reimbursement.