Effect of restricted protein diet supplemented with keto analogues in end-stage renal disease: a systematic review and meta-analysis

Jiang, Zheng; Tang, Yi; Yang, Lichuan; Mi, Xuhua; Qin, Wei

doi:10.1007/s11255-017-1713-9

Cited by 19 publications

(16 citation statements)

References 30 publications

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“…Compared to the latest published systemic review and meta-analysis in 2015, including 9 studies and 410 patients [8], our results included both a greater number of clinical studies (10 RCTs and 2 non-RCT) and a larger sample size (951 patients in total). We not only showed that KA was effective in preventing renal function deterioration and CKD-MBD, but also revealed that KA had a different impact depending on the CKD stage.…”

Section: Discussionmentioning

confidence: 99%

“…However, the benefit of KA on reversing CKD-MDB remained inconclusive [7,15,19,23]. Jiang et al revealed that KA significantly decreased serum phosphorous and PTH levels (phosphorous: MD = −0.20 (−0.29, −0.11), p < 0.0001; PTH: MD = −2.43 (−4.75, −0.11), p = 0.04) but did not affect calcium levels (MD = 0.07 (−0.06, 0.20), p = 0.28) [8]. Our overall results, in contrast, found no significant difference in serum phosphorous, calcium, and PTH between RPKA and placebo groups.…”

Section: Discussionmentioning

confidence: 99%

“…These diets have been proven effective in reducing renal death in selected, well-nourished, progressive CKD patients with proven diet adherence and low-comorbidity [7]. One meta-analysis [8] with stage 3–5 CKD patients who did not enter the maintenance dialysis stage proved that a restricted protein diet supplemented with KAs could delay the progression of CKD, prevent hyperphosphatemia and hyperparathyroidism, and benefit blood pressure control without causing malnutrition.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis

2019

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The effects of ketoanalogues (KA) on chronic kidney disease (CKD) deterioration have not yet been fully confirmed. To strengthen the evidence of the role of KA in CKD, PubMed and Embase were searched for studies published through February 2019. Effect sizes from ten randomized control trials (RCTs) and two non-RCTs comprising a total of 951 patients were pooled and analyzed. A restricted protein diet supplemented with ketoanalogues (RPKA) was found to significantly delay the progression of CKD (p = 0.008), particularly in patients with an estimated glomerular filtration rate (eGFR) > 18 mL/min/1.73 m2 (p < 0.0001). No significant change in eGFR was found when comparing a very-low-protein diet and a low-protein diet (p = 0.10). In addition, compared with the placebo, RPKA did not cause malnutrition (albumin: p = 0.56; cholesterol: p = 0.50). Moreover, RPKA significantly decreased phosphorous levels (p = 0.001), increased calcium levels (p = 0.04), and decreased parathyroid hormone (PTH) levels (p = 0.05) in patients with eGFR < 18 mL/min/1.73 m2. In conclusion, RPKA could slow down the progression of CKD in patients with eGFR > 18 mL/min/1.73 m2 without causing malnutrition and reverse CKD-MBD in patients with eGFR < 18 mL/min/1.73 m2.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis

2019

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“…A low or very low protein diet may improve lipid parameters in CKD patients [22,23] and a low fat diet may improve lipid profile in renal transplant recipients [24]. However, according to a meta-analysis of small trials, a very low protein diet supplemented with keto-analogues has no effect on lipid parameters in ESKD patients [25].…”

Section: Diet and Lifestyle Modificationsmentioning

confidence: 99%

Management of dyslipidaemia in patients with chronic kidney disease: a position paper endorsed by the Italian Society of Nephrology

Pontremoli

Bellizzi

Bianchi³

et al. 2020

J Nephrol

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Chronic kidney disease (CKD) represents a major public health issue worldwide and entails a high burden of cardiovascular events and mortality. Dyslipidaemia is common in patients with CKD and it is characterized by a highly atherogenic profile with relatively low levels of HDL-cholesterol and high levels of triglyceride and oxidized LDL-cholesterol. Overall, current literature indicates that lowering LDL-cholesterol is beneficial for preventing major atherosclerotic events in patients with CKD and in kidney transplant recipients while the evidence is less clear in patients on dialysis. Lipid lowering treatment is recommended in all patients with stage 3 CKD or worse, independently of baseline LDL-cholesterol levels. Statin and ezetimibe are the cornerstones in the management of dyslipidaemia in patients with CKD, however alternative and emerging lipid-lowering therapies may acquire a central role in near future. This position paper endorsed by the Italian Society of Nephrology aims at providing useful information on the topic of dyslipidaemia in CKD and at assisting decision making in the management of these patients.

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“…However, therapeutic ER aims to be balanced, so as to prevent a catabolic process. A protein-restricted diet supplemented with keto analogues can be successfully implemented in advanced CKD without any harm, even with benefits (87) . In any case, any future RCT of energy restriction for CKD should carefully evaluate safety.…”

Section: Safety Of Energy Restriction In Chronic Kidney Diseasementioning

confidence: 99%

The effect of energy restriction on development and progression of chronic kidney disease: review of the current evidence

et al. 2020

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Caloric Restriction (CR) has anti-aging effects and likely protects from a range of chronic diseases including cancer, diabetes, and chronic kidney disease (CKD). Specifically, CR has a positive impact on experimental kidney aging, CKD (diabetic nephropathy, polycystic kidney disease) and acute kidney injury (nephrotoxic, ischemia-reperfusion injury) through such mechanisms as increased autophagy, mitochondrial biogenesis and DNA repair, and decreased inflammation and oxidative stress. Key molecules contributing to CR-mediated kidney protection include AMPK, sirtuin-1 and PGC1α. However, CKD is a complex condition, and CR may potentially worsen CKD complications such as protein energy wasting, bone-mineral disorders and impaired wound healing. CR mimetics are drugs, such as metformin and Sodium-glucose co-transporter-2 which mimic the action of CR. This review aims to provide comprehensive data regarding the effect of CR on CKD progression and outcomes.

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Effect of restricted protein diet supplemented with keto analogues in end-stage renal disease: a systematic review and meta-analysis

Cited by 19 publications

References 30 publications

The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis

The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis

Management of dyslipidaemia in patients with chronic kidney disease: a position paper endorsed by the Italian Society of Nephrology

The effect of energy restriction on development and progression of chronic kidney disease: review of the current evidence

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