Keto-supplemented low protein diet: A valid therapeutic approach for patients with steroid-resistant proteinuria during early-stage chronic kidney disease

Zhang, J.; Xie, Hua; Fang, Ming; Wang, K.; Chen, J.; Sun, Weijian; Yang, Lin; Lin, Hongli

doi:10.1007/s12603-015-0612-y

Cited by 18 publications

(16 citation statements)

References 19 publications

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“…The effect of low protein diet on the change in proteinuria was available in ten trials with 870 participants. [ 13 , 25 , 29 – 31 , 33 , 34 , 37 , 38 ] All the data were extracted from urinary protein excretion with a simple unit conversion. Compared with the control groups, a low-protein diet reduced urinary protein excretion by 0.44 g/day (95% CI: −0.80 to −0.08, P = 0.02, Fig 4 ) with a substantial heterogeneity among the trials ( I 2 = 91.9%).…”

Section: Resultsmentioning

confidence: 99%

Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis

Yan

et al. 2018

PLoS ONE

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BackgroundDietary protein restriction has long been thought to play an important role in the progression of chronic kidney disease (CKD); however, the effect of dietary protein on the rate of decline in kidney function remains controversial.ObjectiveWe undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the influence of protein restriction on chronic kidney disease.MethodOvid MEDLINE (from 1946 to March 5, 2016), EMBASE (from 1966 to March 5, 2016), and the Cochrane Library (Inception to March 5, 2016) were searched to identify RCTs comparing different levels of protein intake for at least 24 weeks in adult patients with CKD. The outcomes included kidney failure events, the rate of change in estimated glomerular filtration rate (eGFR) per year, all cause death events, and changes in proteinuria, serum phosphorus concentration, serum albumin, and body mass index (BMI).ResultsNineteen trials with 2492 subjects were analyzed. A low protein diet reduced the risk of kidney failure (odds ratio (OR) = 0.59, 95% CI: 0.41 to 0.85) and end-stage renal disease (ESRD) (OR = 0.64, 95% CI: 0.43 to 0.96), but did not produce a clear beneficial effect for all cause death events (OR = 1.17, 95% CI: 0.67 to 2.06). The change in the mean difference (MD) for the rate of decline in the eGFR was significant (MD: −1.85, P = 0.001), and for proteinuria (MD: −0.44, P = 0.02). A low protein diet also reduced the serum phosphorus concentration (MD: −0.37, 95% CI: −0.5 to −0.24) and BMI (MD: −0.61, 95% CI: −1.05 to −0.17). However the change in albumin presented no significant difference between two groups (MD: 0.23, 95% CI: −0.51 to 0.97).ConclusionsBased on the findings of our meta-analysis, protein-restricted diet may reduce the rate of decline in renal function and the risk of kidney failure for CKD populations, but did not produce a clear beneficial effect for all cause death events. Besides However, the optimal level of protein intake in different participants is left unanswered, and the nutritional status should be regarded with caution.

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Section: Resultsmentioning

confidence: 99%

Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis

Yan

et al. 2018

PLoS ONE

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“…In the absence of validated nutritional markers in CKD pregnancies, we considered that the stability of serum albumin, in spite of the reduction in protein intake, was in keeping with a positive effect of our low-protein diets on protein balance [ 43 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature

et al. 2017

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Chronic kidney disease (CKD) is increasingly recognized in pregnant patients. Three characteristics are associated with a risk of preterm delivery or small for gestational age babies; kidney function reduction, hypertension, and proteinuria. In pregnancy, the anti-proteinuric agents (ACE–angiotensin converting enzyme-inhibitors or ARBS -angiotensin receptor blockers) have to be discontinued for their potential teratogenicity, and there is no validated approach to control proteinuria. Furthermore, proteinuria usually increases as an effect of therapeutic changes and pregnancy-induced hyperfiltration. Based on a favourable effect of low-protein diets on proteinuria and advanced CKD, our group developed a moderately protein-restricted vegan-vegetarian diet tsupplemented with ketoacids and aminoacids for pregnant patients. This report describes the results obtained in three pregnant patients with normal renal function, nephrotic or sub-nephrotic proteinuria, and biopsy proven diagnosis of focal segmental glomerulosclerosis, a renal lesion in which hyperfiltration is considered of pivotal importance (case 1: GFR (glomerular filtration rate): 103 mL/min; proteinuria 2.1 g/day; albumin 3.2 g/dL; case 2: GFR 86 mL/min, proteinuria 3.03 g/day, albumin 3.4 g/dL; case 3: GFR 142 mL/min, proteinuria 6.3 g/day, albumin 3.23 g/dL). The moderately restricted diet allowed a stabilisation of proteinuria in two cases and a decrease in one. No significant changes in serum creatinine and serum albumin were observed. The three babies were born at term (38 weeks + 3 days, female, weight 3180 g-62th centile; 38 weeks + 2 days, female, weight 3300 g-75th centile; male, 38 weeks + 1 day; 2770 g-8th centile), thus reassuring us of the safety of the diet. In summary, based on these three cases studies and a review of the literature, we suggest that a moderately protein-restricted, supplemented, plant-based diet might contribute to controlling proteinuria in pregnant CKD women with focal segmental glomerulosclerosis. However further studies are warranted to confirm the potential value of such a treatment strategy.

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“…In our patient, it was almost impossible to disentangle the effects on kidney function and proteinuria caused by discontinuation of his vegetable-based, supplemented low-protein diet and those due to weight loss. Our hypothesis is that the increase in proteinuria was related to the discontinuation of his supplemented vegetable-based diet, which we believe led to a reduction in proteinuria [ 47 , 48 , 49 ]. Conversely, we thought that the rapid decrease in kidney function was mainly due to sodium restriction and relative hypotension ( Table 5 ).…”

Section: Discussionmentioning

confidence: 99%

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

Capizzi

Teta²,

Vigotti

et al. 2017

Nutrients

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In advanced chronic kidney disease, obesity may bring a survival advantage, but many transplant centres demand weight loss before wait-listing for kidney graft. The case here described regards a 71-year-old man, with obesity-related glomerulopathy; referral data were: weight 110 kg, Body Mass Index (BMI) 37 kg/m2, serum creatinine (sCr) 5 mg/dL, estimated glomerular filtration rate (eGFR) 23 mL/min, blood urea nitrogen (BUN) 75 mg/dL, proteinuria 2.3 g/day. A moderately restricted, low-protein diet allowed reduction in BUN (45–55 mg/dL) and good metabolic and kidney function stability, with a weight increase of 6 kg. Therefore, he asked to be enrolled in a weight-loss program to be wait-listed (the two nearest transplant centres required a BMI below 30 or 35 kg/m2). Since previous low-calorie diets were not successful and he was against a surgical approach, we chose a qualitative, ad libitum coach-assisted diet, freely available in our unit. In the first phase, the diet is dissociated; he lost 16 kg in 2 months, without need for dialysis. In the second maintenance phase, in which foods are progressively combined, he lost 4 kg in 5 months, allowing wait-listing. Dialysis started one year later, and was followed by weight gain of about 5 kg. He resumed the maintenance diet, and his current body weight, 35 months after the start of the diet, is 94 kg, with a BMI of 31.7 kg/m2, without clinical or biochemical signs of malnutrition. This case suggests that our patients can benefit from the same options available to non-CKD (chronic kidney disease) individuals, provided that strict multidisciplinary surveillance is assured.

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Keto-supplemented low protein diet: A valid therapeutic approach for patients with steroid-resistant proteinuria during early-stage chronic kidney disease

Abstract: sLPD is both nutritionally safe and beneficial, providing nephroprotective effects for early-stage CKD patients with steroid-resistant proteinuria.

Cited by 18 publications

References 19 publications

Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis

Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis

Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

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