Low-salt low-protein diet and blood pressure control in patients with advanced diabetic kidney disease and heavy proteinuria

Ketoanalogue Supplementation in Patients with Non-Dialysis Diabetic Kidney Disease: A Systematic Review and Meta-Analysis

“…A manual review of references cited in the studies yielded 2 additional citations, resulting in a total of 27 articles that were formally assessed for eligibility. Eleven of these studies were identified for the systematic review (Table 2) [2,8,12,[23][24][25][26][27][28][29][30]. Agreement between 2 researchers was high.…”

“…Agreement between 2 researchers was high. Of the 11 studies, 2 included patients with CKD stages 3 or 4 [12,23], 1 with CKD stage 4 [28], 2 with CKD stages 3-5 [2,8], 1 with CKD stages 4 or 5 [27], 2 with CKD stage 5 [26,29], and 3 did not report CKD stages, including patients with nephropathy [24,25,30]. The study periods spanned from 12 weeks to approximately 9 years.…”

“…Dietary compliance was only reported in two studies, showing fewer patients were adherent to a VLPD (45% and 55%) [25,28], compared to those prescribed an LPD (69%) [25]. Eight studies, including a total of 402 analyzed patients, met the selection criteria for quantitative analysis and were used for meta-analyses [2,8,12,[23][24][25]27,30]. Of these 8 studies, 3 were randomized controlled trials (RCT) in DKD, one comparing KA to placebo and to rhubarb [12], one comparing KA alone to KA plus Nigella sativa oil [23], and one comparing KA plus blood pressure medication to blood pressure medication alone [30]; 4 had a pre-post design comparing a previous period on either free diet [24,25] or LPD [8,27] with VLPD or LPD either plus KA, and 1 was a prospective, CKD-controlled, observational study on KA [2].…”

“…Eight studies, including a total of 402 analyzed patients, met the selection criteria for quantitative analysis and were used for meta-analyses [2,8,12,[23][24][25]27,30]. Of these 8 studies, 3 were randomized controlled trials (RCT) in DKD, one comparing KA to placebo and to rhubarb [12], one comparing KA alone to KA plus Nigella sativa oil [23], and one comparing KA plus blood pressure medication to blood pressure medication alone [30]; 4 had a pre-post design comparing a previous period on either free diet [24,25] or LPD [8,27] with VLPD or LPD either plus KA, and 1 was a prospective, CKD-controlled, observational study on KA [2]. Furthermore, 3 of these 8 studies had <40% female participants [8,25,27] and 5 studies ≥40% female participants [2,12,23,24,30]; 3 studies had a follow-up of <6 months [12,23,30] and 5 studies had a follow-up of ≥6 months [2,8,24,25,27].…”

“…Of these 8 studies, 3 were randomized controlled trials (RCT) in DKD, one comparing KA to placebo and to rhubarb [12], one comparing KA alone to KA plus Nigella sativa oil [23], and one comparing KA plus blood pressure medication to blood pressure medication alone [30]; 4 had a pre-post design comparing a previous period on either free diet [24,25] or LPD [8,27] with VLPD or LPD either plus KA, and 1 was a prospective, CKD-controlled, observational study on KA [2]. Furthermore, 3 of these 8 studies had <40% female participants [8,25,27] and 5 studies ≥40% female participants [2,12,23,24,30]; 3 studies had a follow-up of <6 months [12,23,30] and 5 studies had a follow-up of ≥6 months [2,8,24,25,27]. Of the remaining 3 studies not included in the meta-analyses, 2 were retrospective cohort studies using data from the National Health Insurance Research Database in Taiwan comparing KA users vs nonusers [26,29], and 1 was a subgroup analysis of KA-compliant vs. noncompliant patients [28].…”