Low-Protein Diet Supplemented with Keto Acids Is Associated with Suppression of Small-Solute Peritoneal Transport Rate in Peritoneal Dialysis Patients

Abstract

Objective. We investigate whether low-protein diet would show benefits in suppressing peritoneal transport rate in peritoneal dialysis (PD) patients. Methods. This is a supplemented analysis of our previously published trial, which randomized 60 PD patients to receive low- (LP: dietary protein intake of 0.6–0.8 g/kg/d), keto-acid-supplemented low- (sLP: 0.6–0.8 g/kg/d with 0.12 g/kg/d of keto acids), or high- (HP: 1.0–1.2 g/kg/d) protein diet and lasted for one year. In this study, the variations of peritoneal transport rate were assessed. Results. While baseline D/Pcr (dialysate-to-plasma concentration ratio for creatinine at 4 hour) and D/D0glu (dialysate glucose at 4 hour to baseline dialysate glucose concentration ratio) were similar, D/Pcr in group sLP was lower, and D/D0glu was higher than those in the other two groups (P < 0.05) at 12th month. D/D0glu increased (P < 0.05), and D/Pcr tended to decrease, (P = 0.071) in group sLP. Conclusions. Low-protein diet with keto acids may benefit PD patients by maintaining peritoneum at a lower transport rate.

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

“…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).…”

“…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…”

“…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 trials 17,18,[22][23][24][25][26][27][28][29][30]34 as well as meta-analysis studies 12,[35][36][37] have shown the benefits of protein restriction for such conservative management of CKD patients. 38 We found that the risk of progression to ESRD was significantly lower in the LPD compared with higher-protein diets and also found a trend towards greater survival in the former group.…”

Mitochondrial Dysfunction Plays a Relevant Role in Pathophysiology of Peritoneal Membrane Damage Induced by Peritoneal Dialysis

“…In contrast, the median time of PET in our correlation study was 37.7 months after initiation of PD (PD time ≥ 4 months), which allowed us to evaluate this parameter in the long term. Even though there is a statistically significant direct correlation between the peritoneal solute transport rate and free mtDNA levels in the PD effluent, the latter showed a marked variability amongst patients with similar transport rates, suggesting that other factors, such as genetic predisposition or diet, could influence the background properties of the peritoneal membrane [ 43 , 44 , 45 ]. In support of our findings, it has been shown that mtDNA increases enhance endothelial permeability through different pathways [ 46 ].…”

First, Do No Harm: Critical Appraisal of Protein Restriction for Diabetic Kidney Disease

“…These papers were selected because they reported on controlled trials consisting of greater than 30 participants that have examined the effects of low-protein or very low-protein diets on various outcome measures in patients with CKD (Table 2). Among the 18 studies [13,14,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], eight had significantly more favorable results in the intervention group (low-protein diet) than in the control group (normal-protein diet) in terms of study outcomes. However, these studies did not necessarily examine the renal protective effects of low-protein diets.…”