Metabolic effects of two low protein diets in chronic kidney disease stage 4-5--a randomized controlled trial

Cianciaruso, Bruno; Pota, Andrea; Pisani, Antonio; Torraca, Serena; Annecchini, Roberta; Lombardi, P L; Capuano, Alfredo; Nazzaro, Paola; Bellizzi, Vincenzo; Sabbatini, Massimo

doi:10.1093/ndt/gfm576

Cited by 100 publications

(65 citation statements)

References 27 publications

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“…8 Although the favorable metabolic effects of KD were shown in many observational studies, [7][8][9][10][11] the few controlled studies investigating its influence on CKD progression using hard end points were underpowered and gave variable results. [12][13][14][15][16][17][18] However, the risk ratio was in favor of VLPD when studies were pooled together in a recent systematic review (0.63; 95% confidence interval [95% CI], 0.48 to 0.83). 19 The largest study addressing KD, the Modification of Diet in Renal Disease (MDRD) Study 2, provided conflicting results: the protein-restricted diet only marginally reduced the decline in GFR; the advantage was small and apparently caused by the protein restriction, not the ketoanalogues supplementation.…”

mentioning

confidence: 99%

Ketoanalogue-Supplemented Vegetarian Very Low–Protein Diet and CKD Progression

Gârneaţă

Stancu

Dragomir

et al. 2016

JASN

272

259

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Dietary protein restriction may improve determinants of CKD progression. However, the extent of improvement and effect of ketoanalogue supplementation are unclear. We conducted a prospective, randomized, controlled trial of safety and efficacy of ketoanalogue-supplemented vegetarian very low-protein diet (KD) compared with conventional low-protein diet (LPD). Primary end point was RRT initiation or .50% reduction in initial eGFR. Nondiabetic adults with stable eGFR,30 ml/min per 1.73 m 2 , proteinuria ,1 g/g urinary creatinine, good nutritional status, and good diet compliance entered a run-in phase on LPD. After 3 months, compliant patients were randomized to KD (0.3 g/kg vegetable proteins and 1 cps/5 kg ketoanalogues per day) or continue LPD (0.6 g/kg per day) for 15 months. Only 14% of screened patients patients were randomized, with no differences between groups. Adjusted numbers needed to treat (NNTs; 95% confidence interval) to avoid composite primary end point in intention to treat and per-protocol analyses in one patient were 4.4 (4.2 to 5.1) and 4.0 (3.9 to 4.4), respectively, for patients with eGFR,30 ml/min per 1.73 m 2 . Adjusted NNT (95% confidence interval) to avoid dialysis was 22.4 (21.5 to 25.1) for patients with eGFR,30 ml/min per 1.73 m 2 but decreased to 2.7 (2.6 to 3.1) for patients with eGFR,20 ml/min per 1.73 m 2 in intention to treat analysis. Correction of metabolic abnormalities occurred only with KD. Compliance to diet was good, with no changes in nutritional parameters and no adverse reactions. Thus, this KD seems nutritionally safe and could defer dialysis initiation in some patients with CKD.

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mentioning

confidence: 99%

Ketoanalogue-Supplemented Vegetarian Very Low–Protein Diet and CKD Progression

Gârneaţă

Stancu

Dragomir

et al. 2016

JASN

272

259

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“…Starting dialysis in patients older than 75 years old is indeed related to an increased risk of mortality in the first year following initiation of haemodialysis (HD), and to the worsening of physical function and quality of life [29]. Available data show that in patients with moderate-to-advanced CKD, VLPD supplemented with ketoacids improves several metabolic abnormalities, including hyperphosphatemia, metabolic acidosis, hyper-parathyroidism, dyslipidaemia, protein carbamylation and urea levels [30][31][32][33], and contributes to the control of proteinuria, BP and haemoglobin [34][35][36][37], without compromising nutritional status [38,39]. Despite non conclusive data on the role of LPDs in preventing or slowing down additional loss of kidney function, the main role of this diet in more advanced stages of CKD relies in its ability to control CKD-related metabolic abnormalities.…”

Section: Proteinsmentioning

confidence: 99%

“…Despite non conclusive data on the role of LPDs in preventing or slowing down additional loss of kidney function, the main role of this diet in more advanced stages of CKD relies in its ability to control CKD-related metabolic abnormalities. Even a slight reduction in protein intake of 0.2 g/kg/day may significantly improve the uremic state, metabolic acidosis and hyperphosphatemia [32,40].…”

Section: Proteinsmentioning

confidence: 99%

Nutrients, Nutraceuticals and Xenobiotics Affecting Renal Health

Cosola

Sabatino

Bari

et al. 2018

Preprint

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Abstract:Chronic kidney disease (CKD) affects worldwide 8-16% of the population. In developed countries, the most important risk factors for CKD are diabetes, hypertension and obesity, calling into question the importance of educating and acting on lifestyles and nutrition. A balanced nutrition and supplementation can indeed support the maintenance of a general health status, including preservation of renal function, and help to manage and curb the main risk factors for renal damage. While the concepts of protein and salt restriction in nephrology are historically acknowledged, the role of some nutrients on renal health and the importance of nutrition as a preventative measure for renal care are less known.In this review, we provide an overview of the demonstrated and potential actions of some selected nutrients, nutraceuticals and xenobiotics on renal health and function. The effects on kidney of fibres, proteins, fatty acids, curcumin, steviol glycosides, green tea, coffee, nitrates, nitrites, and alcohol, both direct and indirect, in CKD and non-CKD condition, are reviewed here. In a view of a functional and personalized nutrition, understanding the renal and systemic effects of dietary components is essential since many chronic conditions and CKD are related to systemic dysfunctions such as chronic low-grade inflammation.

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“…In CKD stages 3b or advanced (as in this case), a protein prescription of 0.6-0.7 g/kg/d should improve uremia, metabolic acidosis, and hyperparathyroidism (27). To avoid a negative nitrogen balance with such a reduced protein intake, at least 50% of proteins have to be of high biological value (i.e., meat, fish, eggs), and the energy intake should be normalhigh (30-35 kcal/kg/d) (23).…”

Section: What Protein Needs and Amount Of Dietary Protein Should Be Pmentioning

confidence: 99%

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

Bellizzi

Carrero

Chauveau

et al. 2016

Nephrology @ Point of Care

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This is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2 nd International Conference of the European Renal Nutrition working group at ERA-EDTA-"Retarding CKD progression: readily available through comprehensive nutritional management?"-and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections-basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD-linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD)• What nutritional assessment/monitoring for protein-energy wasting (PEW) should be employed?• Is a body mass index (BMI) of 21 kg/m 2 adequate? • What phosphate target should be pursued?• What are the nutritional habits in patients with incident CKD?• What protein needs and amount of dietary protein should be pursued?• Does the quality of protein matter?• What amount of dietary salt should be employed? How should this be obtained?• How should normal serum phosphate be achieved?• What diet should be recommended? Is a vegetarian diet an option?

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Metabolic effects of two low protein diets in chronic kidney disease stage 4-5--a randomized controlled trial

Abstract: This study represents the first evidence that in CKD patients a protein intake of 0.55 g/kg/day, compared with a 0.8 g/kg/day, guarantees a better metabolic control and a reduced need of drugs, without a substantial risk of malnutrition.

Cited by 100 publications

References 27 publications

Ketoanalogue-Supplemented Vegetarian Very Low–Protein Diet and CKD Progression

Ketoanalogue-Supplemented Vegetarian Very Low–Protein Diet and CKD Progression

Nutrients, Nutraceuticals and Xenobiotics Affecting Renal Health

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

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