Optimizing Diet to Slow CKD Progression

Molina, Pablo; Gavela, Eva; Vizcaíno, Belén; Huarte, Emma; Carrero, Juan Jesús

doi:10.3389/fmed.2021.654250

Cited by 32 publications

(25 citation statements)

References 138 publications

(124 reference statements)

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“…A prospective cohort study conducted in Japan reported a null association between total protein and all-cause mortality ( 23 ). Most studies, which analyze the effects of LPD on kidney outcomes have proved the beneficial effects of dietary protein restriction in reducing the decline in renal function and the risk of progression to kidney failure in CKD populations ( 6 , 14 , 37 ). However, unfortunately, the results of a few other studies are not consistent, showing no benefits of protein restriction for patients with CKD ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although genetic factors play an important role in the incidence and progression of CKD, most cases are attributed to nutritional factors and are largely preventable ( 5 ). Therefore, dietary modifications and maintaining adequate nutrient homeostasis should be a fundamental strategy in treating patients with CKD ( 6 ). For several decades, low protein intake has been recommended for patients with CKD to slow its progression to end-stage kidney disease and delay renal replacement therapy ( 7 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

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The Association Between Total Protein Intake and All-Cause Mortality in Middle Aged and Older Korean Adults With Chronic Kidney Disease

et al. 2022

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Background and AimsOver the past decades, the optimum protein intake for patients with chronic kidney disease (CKD) has been an important, controversial issue. Dietary protein restriction has been commonly recommended for patients with CKD for preserving kidney function. However, evidence of the associations between long-term protein intake and mortality is not consistent in patients with CKD. Therefore, we aimed to examine the associations between total protein intake and all-cause mortality in Korean adults with CKD.MethodsFrom three sub-cohorts of the Korean Genome and Epidemiology Study (KoGES) starting from 2001, total 3,892 participants with eGFR < 60 mL/min/1.73 m2 (CKD stage 3–5) were included in this study. Dietary data were collected using food-frequency questionnaires at baseline. Deaths were followed from 2001 to 2019. Cox proportional hazards regression model was used to evaluate the association between protein intake and all-cause mortality.ResultsDuring a median follow-up (min-max) of 11.1 years (0.3–15.1), 602 deaths due to all causes of mortality were documented. After adjustment for covariates, higher total protein intake was not associated with all-cause mortality [highest vs. lowest quintile of total protein intake (g/kg/day) and proportion (%) (Q5 vs. Q1), HR = 1.14 (0.75–1.72), and HR = 0.87 (0.67–1.13)] in CKD stage 3–5 patients.ConclusionDietary protein intake was not associated with mortality from all causes in patients with CKD. Further research is needed to establish optimal protein intake levels and examine the impact of the dietary source of protein on various health outcomes and mortality in CKD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association Between Total Protein Intake and All-Cause Mortality in Middle Aged and Older Korean Adults With Chronic Kidney Disease

et al. 2022

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“…Furthermore, research indicates that post-KTx proteinuria can be controlled through the diet [40]. A nutritional intervention to control protein intake could contribute to reduce the overload of protein levels in the glomerular capillaries and renal tubules [41][42][43][44][45]. As a result, hyperfiltration and glomerular pressure decrease, reducing the urinary protein excretion rate [44,45].…”

Section: Discussionmentioning

confidence: 99%

Effects of an individualized nutritional intervention on kidney function, body composition, and quality of life in kidney transplant recipients: Study protocol for a randomized clinical trial

et al. 2022

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Background Proteinuria after kidney transplantation (KTx) has been a frequent problem due to several factors, high protein intake being one of them. Individualized nutritional intervention in the late post-KTx period can promote the improvement or the reduction of risks associated with the parameters of evaluation of kidney function, body composition, and quality of life in individuals submitted to KTx. Methods This is a single-center, randomized and stratified clinical trial. The study will be conducted in a university hospital in northeastern Brazil with 174 individuals aged ≥19 years submitted to KTx and followed up for 12 months. Assessments will take place at 3-month intervals (T0, T3, T6, T9, and T12). The patients will be allocated to intervention and control groups by random allocation. The intervention group will receive individualized nutritional interventions with normoproteic diets (1.0 g/kg) after 60 days of KTx whereas the controls will receive the standard nutritional guidance for the post-KTx period. The primary efficacy variable is the change from baseline in log proteinuria assessed with the urinary albumin/creatinine ratio. Secondary efficacy variables include body composition, anthropometry, quality of life assessment and physical activity, lipid profile and glycemic control. Ninety-two subjects per group will afford 70% power to detect a difference of 25% between groups in log proteinuria. Primary efficacy analysis will be on the modified intention-to-treat population with between-groups comparison of the change from baseline in log proteinuria by analysis of covariance. Discussion The study will assess the effects of an individualized nutritional intervention on proteinuria 12 months after KTx. Trial registration REBEC (RBR-8XBQK5).

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“…The model can be used to guide future cancer research to test whether modification or reversal of dysregulated phosphate metabolism through dietary interventions can alter the clinical course of cancer. Restricted-phosphate diets are currently used to modify the progression of chronic kidney disease [89], and similar diets should be tested for use in patients with obesity-related cancers.…”

Section: Summary and Future Directionsmentioning

confidence: 99%

Obesity and Cancer: Potential Mediation by Dysregulated Dietary Phosphate

Brown

2022

Obesities

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Next to smoking, obesity is the second leading preventable risk factor for cancer, but increasing rates of obesity and overweight are estimated to overtake smoking as the leading preventable cancer risk factor. Few research studies have investigated the dysregulated endocrine metabolism of dietary phosphate as a potential mediating factor in the association of obesity with cancer. Phosphate toxicity, the accumulation of excess phosphate in the body from dysregulated phosphate metabolism, is associated with tumorigenesis. High levels of hormones that regulate phosphate metabolism, such as parathyroid hormone and fibroblast growth factor 23, are also associated with obesity, providing a potential link between obesity and phosphate toxicity. Increased dietary intake of inorganic phosphate is linked to excessive consumption of foods processed with phosphate additives, and consumption of ultra-processed foods is associated with an increase in the incidence of obesity. Sugar-sweetened beverages provide the single largest source of sugar and energy intake in the U.S. population, and colas containing phosphoric acid are associated with tumorigenesis, suggesting another potential connection between obesity and cancer. Furthermore, dietary phosphate is positively correlated with increases in obesity, central obesity, and metabolic syndrome. The present perspective article proposes that dysregulated dietary phosphate potentially mediates the association of obesity with cancer.

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Optimizing Diet to Slow CKD Progression

Cited by 32 publications

References 138 publications

The Association Between Total Protein Intake and All-Cause Mortality in Middle Aged and Older Korean Adults With Chronic Kidney Disease

The Association Between Total Protein Intake and All-Cause Mortality in Middle Aged and Older Korean Adults With Chronic Kidney Disease

Effects of an individualized nutritional intervention on kidney function, body composition, and quality of life in kidney transplant recipients: Study protocol for a randomized clinical trial

Obesity and Cancer: Potential Mediation by Dysregulated Dietary Phosphate

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