Effect of Short-Term Low-Protein Diet Supplemented with Keto Acids on Hyperphosphatemia in Maintenance Hemodialysis Patients

Abstract

Aim: To evaluate the effects of short-term restriction of dietary protein intake (DPI) supplemented with keto acids on hyperphosphatemia in maintenance hemodialysis (MHD) patients. Methods: Forty MHD patients with uncontrolled hyperphosphatemia were randomized to either low DPI with keto acid-supplemented (sLP) or normal DPI (NP) group for 8 weeks. After 8 weeks, the sLP group was shifted to NP for another 8 weeks. Low-protein diet (LPD) was individualized with total caloric intake 30–35 kcal/kg/day, protein intake of 0.8 g/kg/day and phosphate intake of 500 mg/day. Keto acids were supplied in a dosage of 12 pills per day. Calcium phosphorous metabolism index and nutritional index (serum albumin, total protein, somatometric measurements, 3-day diaries and Mini-Nutritional Assessment score) were recorded. C-reactive protein, CO₂ combining power and Kt/V were measured to evaluate the inflammation, metabolic acidosis and dialysis adequacy, respectively. Results: Serum phosphorus level and calcium-phosphate product were significantly decreased at the end of the first 8 weeks in the sLP group compared to the basal value and the NP group (p < 0.001). No difference was observed in C-reactive protein, Kt/V and nutritional index, while CO₂ combining power was significantly higher at week 8 in the sLP group (p < 0.001). Conclusion: Short-term restriction of DPI supplemented with keto acids could decrease hyperphosphatemia and calcium-phosphate product, while keeping stable nutritional status among MHD patients.

Daily Protein Intake and Patient Outcomes in Severe Acute Kidney Injury: Findings of the Randomized Evaluation of Normal versus Augmented Level of Replacement Therapy (RENAL) Trial

“…Moreover, studies of supplemental [36] and early parenteral nutrition [37] have delivered contradictory findings. Thus, it is not surprising that our understanding of optimal protein intake in renal disease, which is limited in patients with chronic kidney disease [38], in those on chronic dialysis [39], and in patients receiving continuous or intermittent extended RRT [40,41,42] generates great variability in feeding practices in ICU [20,43]. …”

Association of Circulating Fibroblast Growth Factor-23 with Renal Phosphate Excretion among Hemodialysis Patients with Residual Renal Function

“…Our data confirmed that the excessive daily protein intake was one of the important reasons for high incidence of hyperphosphatemia in such a group of patients. Li et al recently showed that 2-month restriction of dietary protein intake (0.8 g/kg per day) supplemented with keto acids significantly decreased serum phosphate levels in anuric MHD patients with refractory hyperphosphatemia, and did not induce malnutrition (37). Although protein intake is recommended to be 1.2 g/kg per day in MHD patients by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines (38), the optimal protein intake may also need to be individualized in different patients, especially for patients without RRF and treated with a low dose of dialysis (39).…”

The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach

“…The role of animal-derived proteins in human nutrition has been reassessed in recent years, yet this critical analysis has not been fully extended to CKD and dialysis patients, for whom the equation “high quality protein = animal-derived protein = best protein” is still the basis for prescription, even if the interest on plant-based diets in all CKD stages is increasing [106,107,108,109,110,111,160,161,162]. …”

“…A more liberal intake of plant-derived phosphate, together with attention to avoiding food additives, is probably compatible with good metabolic control and less need for phosphate binders, which account for a relevant portion of the pill burden in dialysis patients [160,161,162,163,164,165,166,167]. The awareness that hyperphoshatemia reflects a variety of nutritional and non-nutritional derangements can guide tailored interventions [167] (Figure 3).…”