Adherence to ketoacids/essential amino acids-supplemented low protein diets and new indications for patients with chronic kidney disease

Fouque, Denis; Chen, Jing; Chen, Wei; Gârneaţă, Liliana; Hwang, SJ; Kalantar-Zadeh, Kamyar; Kopple, Joel D.; Mitch, William E.; Piccoli, Giorgina Barbara; Teplan, Vladimı́r; Chauveau, P.

doi:10.1186/s12882-016-0278-7

Cited by 28 publications

(26 citation statements)

References 28 publications

(30 reference statements)

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“…VLPD supplemented with keto-analogs also ameliorated erythropoietin responsiveness. [23,41] These metabolic advantages of LPD in CKD aid better control of uremic symptoms, decrease in cardiovascular risk, and less medications leading to better adherence. [42]…”

Section: Benefits Of Protein Restriction In Patients With Chronic Kidmentioning

confidence: 99%

“…Although psychosocial factors such as knowledge, attitude, and support, are among the most important determinants of adherence, [10] successful adherence was hardly predictable. [41] Good patient-physician communication, self-monitoring of protein intake, and periodic feedback by the dietitian strengthens adherence through improved recognition of the importance of diet. [63] Education with simplified diet approach could also assist in robust adherence.…”

Section: The Challenge Of Adherence To Low Protein Dietmentioning

confidence: 99%

“…[41] EAAs need to be obtained from food, because it could not be generated in the body. Meanwhile, keto-analogs, formed by transamination of EAAs except lysine and threonine, can be utilized through their conversion to respective EAAs without providing nitrogen products.…”

Section: Essential Amino-acid and Ketoanalog Supplemented Very-low Prmentioning

confidence: 99%

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Dietary protein intake and chronic kidney disease

Ko¹,

Obi

Tortorici

et al. 2017

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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177

117

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Purpose of review High protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration. This can cause damage to glomerular structure leading to or aggravating chronic kidney disease (CKD). Hence, a low protein diet (LPD) of 0.6–0.8 g/kg/day is often recommended for the management of CKD. We reviewed the effect of protein intake on incidence and progression of CKD and the role of LPD the CKD management. Recent findings Actual dietary protein consumption in CKD patients remain substantially higher than the recommendations for LPD. Notwithstanding the inconclusive results of the Modification of Diet in Renal Disease (MDRD) study, the largest randomized controlled trial to examine protein restriction in CKD, several prior and subsequent studies and meta-analyses including secondary analyses of the MDRD data appear to support the role of LPD on retarding progression of CKD and delaying initiation of maintenance dialysis therapy. LPD can also be used to control metabolic derangements in CKD. Supplemented LPD with essential amino acids or their keto-analogs may be used for incremental transition to dialysis especially in non-dialysis days. An LPD management in lieu of dialysis therapy can reduce costs, enhance psychological adaptation, and preserve residual renal function upon transition to dialysis. Adherence and adequate protein and energy intake should be ensured to avoid protein-energy wasting. Summary A balanced and individualized dietary approach based on LPD should be elaborated with periodic dietitian counselling and surveillance to optimize management of CKD, to assure adequate protein and energy intake and to avoid or correct protein-energy wasting.

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Section: Benefits Of Protein Restriction In Patients With Chronic Kidmentioning

confidence: 99%

Section: The Challenge Of Adherence To Low Protein Dietmentioning

confidence: 99%

See 1 more Smart Citation

Dietary protein intake and chronic kidney disease

Ko¹,

Obi

Tortorici

et al. 2017

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

Self Cite

177

117

View full text Add to dashboard Cite

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“…Traditionally, restricted protein diets of 0.6–0.8 g protein per kilogram of bodyweight daily have been recommended in non‐dialysis, advanced CKD populations to reduce the accumulation of uraemic wastes and the development of associated symptoms . In addition, very‐low‐protein diets supplemented with keto‐analogues have been shown to be efficacious, however, are poorly adhered to . Keto‐analogues are not available in clinical practice in many countries, including Australia, and these restrictive plans do not reflect the goals of CKD‐RSC such as to enhance dietary flexibility and personal choice.…”

Section: Nutrition Counsellingmentioning

confidence: 99%

“…3 In addition, verylow-protein diets supplemented with keto-analogues have been shown to be efficacious, however, are poorly adhered to. 18 Keto-analogues are not available in clinical practice in many countries, including Australia, and these restrictive plans do not reflect the goals of CKD-RSC such as to enhance dietary flexibility and personal choice. The benefits of progressive resistance training in elderly, CKD populations are described elsewhere and have been shown to improve muscle strength and function 15,16 with protein intakes of 0.6-0.8 g/kg per day, provided energy intake is adequate.…”

Section: Reduce Diet-related Anxietymentioning

confidence: 99%

Nutrition in Renal Supportive Care: Patient‐driven and flexible

et al. 2017

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Renal Supportive Care is an alternative treatment pathway in advanced chronic kidney disease that is being increasingly adopted, particularly in the elderly. Renal Supportive Care uses principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non‐dialysis pathway. Nutrition management is often an under‐recognized component of care and can play an important role in improving patients' quality of life to reduce symptom burden, support physical function and independence and provide appropriate counselling to patients and their families to ensure the goals of Renal Supportive Care are met. Nutrition interventions need to target patient and treatment goals, with frequent monitoring to ensure patient needs are being met. This review outlines available literature on this topic and suggests some practical ways in which nutrition can be enhanced for these patients.

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