nutrients Article Quality of Life in CKD Patients on Low-Protein Diets in a Multiple-Choice Diet System. Comparison between a French and an Italian Experience Antioco Fois 1 , Massimo Torreggiani 1 , Tiziana Trabace 1 , Antoine Chatrenet 1 , Elisa Longhitano 2 , Béatrice Mazé 1 , Francoise Lippi 1 , Jerome Vigreux 1 , Coralie Beaumont 1 , Maria Rita Moio 1 and Giorgina Barbara Piccoli 1, *   Citation: Fois, A.; Torreggiani, M.; Trabace, T.; Chatrenet, A.; Longhitano, E.; Mazé, B.; Lippi, F.; Vigreux, J.; Beaumont, C.; Moio, M.R.; et al. Quality of Life in CKD Patients on Low-Protein Diets in a Multiple- Choice Diet System. Comparison between a French and an Italian Experience. Nutrients 2021, 13, 1354. https://doi.org/10.3390/nu13041354 Academic Editor: Vassilios Liakopoulos Received: 17 March 2021 Accepted: 15 April 2021 Published: 18 April 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Nèphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; afois@ch-lemans.fr (A.F.); maxtorreggiani@hotmail.com (M.T.); tizi.trb87@gmail.com (T.T.); achatrenet@ch-lemans.fr (A.C.); bmaze@ch-lemans.fr (B.M.); flippi@ch-lemans.fr (F.L.); jvigreux@ch-lemans.fr (J.V.); cbeaumont@ch-lemans.fr (C.B.); mariaritamoio@gmail.com (M.R.M.) 2 Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.O.U. “G. Martino”, University of Messina, 98124 Messina, Italy; elisa.longhitano@libero.it * Correspondence: gbpiccoli@yahoo.it; Tel.: +33-66-973-3371 Abstract: Prescribing a low-protein diet (LPD) is part of the standard management of patients in advanced stages of chronic kidney disease (CKD). However, studies on the quality of life (QoL) of patients on LPDs are lacking, and the impact these diets have on their QoL is often given as a reason for not prescribing one. We, therefore, decided to assess the QoL in a cohort of CKD stage 3–5 patients followed up by a multiple-choice diet approach in an outpatient nephrology clinic in France. To do so, we used the short version of the World Health Organization’s quality of life questionnaire and compared the results with a historical cohort of Italian patients. We enrolled 153 patients, managed with tailored protein restriction in Le Mans, and compared them with 128 patients on similar diets who had been followed in Turin (Italy). We found there were no significant differences in terms of age (median 73 vs. 74 years, respectively), gender, CKD stage, and comorbidities (Charlson’s Comorbidity Index 7 vs. 6). French patients displayed a greater body mass index (29.0 vs. 25.4, p < 0.001) and prevalence of obesity (41.2 vs. 15.0%, p < 0.001). Baseline protein intake was over the target in France (1.2 g/kg of real body weight/day). In both cohorts, the burden of comorbidities was associated with poorer physical health perception while kidney function was inversely correlated to satisfaction with social life, independently of the type of diet. Our study suggests that the type of LPD they follow does not influence QoL in CKD patients and that a personalized approach towards protein restriction is feasible, even in elderly patients. Keywords: low-protein diet; elderly; CKD; chronic kidney disease 1. Introduction The central importance of low-protein diets (LPD) in the management of chronic kidney disease (CKD) was recently underlined in the new KDOQI guidelines on nutrition in kidney diseases, which highlight the advantages of protein restriction and broaden the perimeter of action of these diets, suggesting that low-and very low-protein diets (LPD and vLPD), respectively, defined as supplying 0.6 g (moderate protein restriction) or 0.3–0.4 g of proteins per kg of ideal body weight per day, may be indicated as early as CKD stage 3 [1]. While these positions reinforce the enthusiasm of teams that have experience in using dietary management for patients with CKD, perplexities about their feasibility persist. Frequently, three points are raised: the risk of malnutrition, the difficulties encountered in obtaining compliance, and the risk of affecting a quality of life that is already threatened by a chronic disease [2,3]. Nutrients 2021, 13, 1354. https://doi.org/10.3390/nu13041354 https://www.mdpi.com/journal/nutrients