Effects of Severe Protein Restriction with Ketoanalogues in Advanced Renal Failure

Malvy, Denis; Maingourd, Claude; Pengloan, J; Bagros, P; Nivet, Hubert

doi:10.1080/07315724.1999.10718887

Cited by 67 publications

(70 citation statements)

References 21 publications

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“…and Rosman et al 23. However, it was significantly higher in the study by Malvy et al 28. with a longer follow‐up duration (serum calcium: 2.42 vs. 2.25 mmol/L; P < 0.01).…”

Section: Resultsmentioning

confidence: 61%

“…and Ihle et al 22. However, Malvy et al 28. completed a longer follow‐up (up to 40 months) and revealed a significantly lower PTH in those who received a lower protein intake (mean PTH: 2.71 vs. 5.91 ng/mL; P < 0.001).…”

Section: Resultsmentioning

confidence: 95%

“…Based on the interventions and comparisons, the included studies were divided into the following groups: (i) those comparing LPD with higher‐protein diets10, 17, 18, 19, 20, 21, 22, 23, 24; (ii) those comparing VLPD with LPD10, 25, 26, 27, 28, 29, 30; and (iii) those involving other comparisons31, 32 ( Table 1). As all studies were not similar in their recruited patients and/or outcome measures, not all studies in each category were meta‐analysed ( Figures 2 and 3).…”

Section: Resultsmentioning

confidence: 99%

“…Even though the latter is of immense clinical importance, many clinicians often encounter patients in very late stages of CKD, for example, estimated GFR < 25 mL/min/1.73m 2 , who wish to avoid or defer dialysis therapy by any means possible. Several individual trials17, 18, 22, 23, 24, 25, 26, 27, 28, 29, 30, 34 as well as meta‐analysis studies12, 35, 36, 37 have shown the benefits of protein restriction for such conservative management of CKD patients 38…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

Rhee

Ahmadi

Kövesdy

et al. 2017

J cachexia sarcopenia muscle

158

126

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BackgroundRecent data pose the question whether conservative management of chronic kidney disease (CKD) by means of a low‐protein diet can be a safe and effective means to avoid or defer transition to dialysis therapy without causing protein‐energy wasting or cachexia. We aimed to systematically review and meta‐analyse the controlled clinical trials with adequate participants in each trial, providing rigorous contemporary evidence of the impact of a low‐protein diet in the management of uraemia and its complications in patients with CKD.MethodsWe searched MEDLINE (PubMed) and other sources for controlled trials on CKD to compare clinical management of CKD patients under various levels of dietary protein intake or to compare restricted protein intake with other interventions. Studies with similar patients, interventions, and outcomes were included in the meta‐analyses.ResultsWe identified 16 controlled trials of low‐protein diet in CKD that met the stringent qualification criteria including having 30 or more participants. Compared with diets with protein intake of >0.8 g/kg/day, diets with restricted protein intake (<0.8 g/kg/day) were associated with higher serum bicarbonate levels, lower phosphorus levels, lower azotemia, lower rates of progression to end‐stage renal disease, and a trend towards lower rates of all‐cause death. In addition, very‐low‐protein diets (protein intake <0.4 g/kg/day) were associated with greater preservation of kidney function and reduction in the rate of progression to end‐stage renal disease. Safety and adherence to a low‐protein diet was not inferior to a normal protein diet, and there was no difference in the rate of malnutrition or protein‐energy wasting.ConclusionsIn this pooled analysis of moderate‐size controlled trials, a low‐protein diet appears to enhance the conservative management of non‐dialysis‐dependent CKD and may be considered as a potential option for CKD patients who wish to avoid or defer dialysis initiation and to slow down the progression of CKD, while the risk of protein‐energy wasting and cachexia remains minimal.

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“…and Rosman et al 23. However, it was significantly higher in the study by Malvy et al 28. with a longer follow‐up duration (serum calcium: 2.42 vs. 2.25 mmol/L; P < 0.01).…”

Section: Resultsmentioning

confidence: 61%

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

Rhee

Ahmadi

Kövesdy

et al. 2017

J cachexia sarcopenia muscle

158

126

View full text Add to dashboard Cite

show abstract

“…One advantage of using VLPD þ KA is the reduction in serum urea nitrogen as demonstrated in many studies (Forget et al, 1990;Malvy et al, 1999;Aparicio et al, 2000). In fact, a 28.9% of decrease in this biochemical marker was found in our study contrasting with only 7.9% in the LPD group.…”

Section: Discussionmentioning

confidence: 99%

Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients

et al. 2004

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Objective: To evaluate the effects on the nutritional and metabolic parameters of a very-low-protein diet supplemented with ketoacids (VLPD þ KA) in comparison with a conventional low-protein diet (LPD) in chronic kidney disease (CKD) patients. Design: Prospective, randomized, controlled clinical study. Setting: Outpatient Clinic of the Nephrology Division of Federal University of São Paulo, Brazil. Subjects: The study involved 24 patients with advanced CKD (creatinine clearance o25 ml/min) that were randomly assigned to either a VLPD þ KA (VLPD þ KA group, 12 patients) or to a conventional LPD with 0.6 g/kg/day (LPD group, 12 patients). The patients were followed for 4 months. Results: Nutritional status was adequately maintained with both diets for the studied period. Protein intake and serum urea nitrogen decreased significantly only in the VLPD þ KA group (from 0.6870.17 to 0.4370.12 g/kg/day, Po0.05; from 61.4712.8 to 43.6714.9 mg/dl, Po0.001; respectively). Ionized calcium did not change in the VLPD þ KA group but tended to decrease in the LPD group. Serum phosphorus tended to decrease in the VLPD þ KA group probably as a result of a significant reduction in dietary phosphorus (5297109 to 3737125 mg/day, Po0.05) associated to the phosphorus-binding effect of the ketoacids. No change in these parameters was found in the LPD group. Serum parathormone increased significantly only in the LPD group (from 2417138 to 4947390 pg/ml, Po0.01). The change in PTH concentration was negatively correlated with changes in ionized calcium concentration (r ¼ À0.75, P ¼ 0.02) and positively correlated with changes in serum phosphorus (r ¼ 0.71, P ¼ 0.03) only in the LPD group. Conclusion: This study indicates that a VLPD þ KA can maintain the nutritional status of the patients similarly to a conventional LPD. Besides, an improvement in calcium and phosphorus metabolism and a reduction in serum urea nitrogen were attained only with the VLPD þ KA. Thus, VLPD þ KA can constitute another efficient therapeutic alternative in the treatment of CKD patients. Sponsorship: This study was supported by CAPES, Oswaldo Ramos Foundation and Fresenius Kabi, Ltda.

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Low protein diets for chronic kidney disease in non diabetic adults

Fouque¹,

Laville

Boissel

2006

Cochrane Database of Systematic Reviews

115

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Effects of Severe Protein Restriction with Ketoanalogues in Advanced Renal Failure

Abstract: Compared to a moderate protein restriction (0.65 g/kg/day), a severe protein restriction (0.3 g/kg/day) supplemented by ketoanologues does not limit GFR decrease when GFR is below 20 mL/min/1.73m2, but improves phosphocalcic plasma parameters.

Cited by 67 publications

References 21 publications

Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients

Low protein diets for chronic kidney disease in non diabetic adults

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