Vegetarian low-protein diets supplemented with keto analogues: a niche for the few or an option for many?

Piccoli, Giorgina Barbara; Ferraresi, Martina; Deagostini, Maria Chiara; Vigotti, Federica Neve; Consiglio, Valentina; Scognamiglio, Stefania; Moro, Irene; Clari, Roberta; Fassio, Federica; Biolcati, Marilisa; Porpiglia, Francesco

doi:10.1093/ndt/gft092

Cited by 44 publications

(59 citation statements)

References 39 publications

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“…18,21,23 Less than one half of our patients fulfilling the selection criteria accepted to potentially follow a vegetarian diet, and only 14% proved compliant during the run-in phase and could be, therefore, randomized, a proportion that is higher than that recently reported by Piccoli et al 27 (1.5%). Compliance to LPDs could also be a problem.…”

Section: Discussionmentioning

confidence: 54%

“…Only 3% of our patients, equally distributed in the study arms, discontinued the diet, but those continuing the study showed excellent compliance to both protein and energy intake. This could be a center effect, because in other reports, 16% of patients chose to discontinue the KD diet, 27 and the compliance to an even less protein-restricted diet (0.55 g/kg per day) was only 27% and inversely related to the severity of protein restriction. 17 Nevertheless, our experience suggests that appropriate selection of patients, intensive counseling, and close monitoring could improve compliance.…”

Section: Discussionmentioning

confidence: 97%

“…Recent studies focused on the advantages of the LPD in certain groups of patients with CKD (the elderly, in whom ketoanalogue-supplemented VLPD seems a better alternative to dialysis), 26 patients' selection aiming to increase compliance, 17 or modification of diets to make them more acceptable. 27 Moreover, the dietary approaches to stop hypertension diet is now largely accepted in cardiology, 28,29 and diet is the first step recommended in correction of acidosis and hyperkalemia associated to CKD. 5 Accordingly, we aimed to evaluate the effectiveness and safety of a vegetarian VLPD supplemented with ketoanalogues of essential amino acids in reducing CKD progression.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

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

Gârneaţă

Stancu

Dragomir

et al. 2016

JASN

272

259

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“…In many developing countries, the use of vegetarian diets along with keto acids has been shown to delay progression as well. [28][29][30][31][32][33] The switch to emphasizing higher protein ($1.0 g/kg/day) intake starts when the patient is in kidney failure and undergoing maintenance dialysis therapy. 34 Protein-energy wasting and chronic inflammation associated with malnutrition are often associated with hypoalbuminemia.…”

Section: Emphasis On Serum Albumin and Dietary Protein Qualitymentioning

confidence: 99%

Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary

Beto¹,

Schury²,

Bansal³

2016

IJNRD

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Chronic kidney disease (CKD) requires extensive changes to food and lifestyle. Poor adherence to diet, medications, and treatments has been estimated to vary between 20% and 70%, which in turn can contribute to increased mortality and morbidity. Delivering effective nutritional advice in patients with CKD coordinates multiple diet components including calories, protein, sodium, potassium, calcium, phosphorus, and fluid. Dietary intake studies have shown difficulty in adhering to the scope and complexity of the CKD diet parameters. No single educational or clinical strategy has been shown to be consistently effective across CKD populations. Highest adherence has been observed when both diet and education efforts are individualized to each patient and adapted over time to changing lifestyle and CKD variables. This narrative review and commentary summarizes nutrition education literature and published strategies for providing nutritional advice in CKD. A cohort of practical and effective strategies for increasing dietary adherence to nutritional advice are provided that include communicating with "talking control" principles, integrating patient-owned technology, acknowledging the typical food pattern may be snacking rather than formal meals, focusing on a single goal rather than multiple goals, creating active learning and coping strategies (frozen sandwiches, visual hands-on activities, planting herb gardens), and involving the total patient food environment.

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“…Our diet for nonpregnant patients is vegan, with a protein intake of 0.6 g/kg per day (ideal weight), one to three free meals per week, and keto acid supplementation of 1 pill/8-10 kg ideal BW (IBW) (31,40).…”

Section: Low-protein Dietmentioning

confidence: 99%

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Piccoli¹,

Leone²,

Attini

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Women affected by CKD increasingly choose to get pregnant. Experience with lowprotein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets.Design, setting, participants, & measurements This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (.1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies-21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 proteinunrestricted meals allowed per week.Results Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P,0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups.Conclusion Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.

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Vegetarian low-protein diets supplemented with keto analogues: a niche for the few or an option for many?

Abstract: Our data suggest a wider offer of LPD-KA to patients with severe and progressive CKD. The promising results in terms of mortality and progression need confirmation with different study designs.

Cited by 44 publications

References 39 publications

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

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

Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

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