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Published in: International Urology and Nephrology 4/2018

01-04-2018 | Nephrology - Review

Effect of restricted protein diet supplemented with keto analogues in end-stage renal disease: a systematic review and meta-analysis

Authors: Zheng Jiang, Yi Tang, Lichuan Yang, Xuhua Mi, Wei Qin

Published in: International Urology and Nephrology | Issue 4/2018

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Abstract

Aim

To evaluate the efficacy and safety of the restricted protein diet supplemented with keto analogues when applied in end-stage renal disease (ESRD).

Methods

The Cochrane Library, PubMed, Embase, CBM and CENTRAL databases were searched and reviewed up to January 2017. Clinical trials were analyzed using RevMan 5.3 software.

Results

Five randomized controlled trials were selected and included in this study according to our inclusion and exclusion criteria. Changes in serum albumin, PTH, triglyceride, cholesterol, calcium, phosphorus, hemoglobin, Kt/v and CRP before and after treatment were analyzed. Meta-analysis results indicated that, compared with normal protein diet, low-protein diet (LPD) supplemented with keto analogues (sLPD) could improve serum albumin (P < 0.00001), hyperparathyroidism (P < 0.00001) and hyperphosphatemia (P = 0.008). No differences in triglyceride, cholesterol, hemoglobin, Kt/v and CRP were observed between different protein intake groups.

Conclusion

Restricted protein diet supplemented with keto analogues (sLPD) may improve nutritional status and prevent hyperparathyroidism in ESRD patients. The current data were mainly obtained from short-term, single-center trails with small sample sizes and limited nutritional status indexes, indicating a need for further study.
Literature
1.
go back to reference Imai E, Matsuo S (2008) Chronic kidney disease in Asia. The Lancet 371(9631):2147–2148CrossRef Imai E, Matsuo S (2008) Chronic kidney disease in Asia. The Lancet 371(9631):2147–2148CrossRef
2.
go back to reference Kovesdy CP, Kalantar-Zadeh K (2012) Enter the dragon: a Chinese epidemic of chronic kidney disease? The Lancet 379(9818):783–785CrossRef Kovesdy CP, Kalantar-Zadeh K (2012) Enter the dragon: a Chinese epidemic of chronic kidney disease? The Lancet 379(9818):783–785CrossRef
3.
go back to reference Zhang L et al (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822CrossRefPubMed Zhang L et al (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822CrossRefPubMed
4.
go back to reference Saran R et al (2016) US renal data system 2015 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 67(3 Suppl 1):Svii, S1–Svii S305 Saran R et al (2016) US renal data system 2015 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 67(3 Suppl 1):Svii, S1–Svii S305
5.
go back to reference Wanner C, Amann K, Shoji T (2016) The heart and vascular system in dialysis. Lancet 388(10041):276–284CrossRefPubMed Wanner C, Amann K, Shoji T (2016) The heart and vascular system in dialysis. Lancet 388(10041):276–284CrossRefPubMed
6.
go back to reference Sabatino A et al (2017) Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clin Nutr 36(3):663–671CrossRefPubMed Sabatino A et al (2017) Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clin Nutr 36(3):663–671CrossRefPubMed
7.
go back to reference Bellizzi V et al (2015) Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrol Dial Transplant 30(1):71–77CrossRefPubMed Bellizzi V et al (2015) Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrol Dial Transplant 30(1):71–77CrossRefPubMed
8.
go back to reference Jiang Z et al (2016) Effect of restricted protein diet supplemented with keto analogues in chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol 48(3):409–418CrossRefPubMed Jiang Z et al (2016) Effect of restricted protein diet supplemented with keto analogues in chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol 48(3):409–418CrossRefPubMed
9.
go back to reference Liang J et al (2015) The Effect of α-Ketoacid in Treating Dialysis patients. Chin J of Clin Ration Drug Use 8(5C):120–121 (article in Chinese) Liang J et al (2015) The Effect of α-Ketoacid in Treating Dialysis patients. Chin J of Clin Ration Drug Use 8(5C):120–121 (article in Chinese)
10.
go back to reference Zhou S et al (2013) Effect of low protein diet combined a-keto acid on calcium and phosphorus metabolism in patients with maintenance hemodialysis. J Clin Med Pract 17(9):111–113 (article in Chinese) Zhou S et al (2013) Effect of low protein diet combined a-keto acid on calcium and phosphorus metabolism in patients with maintenance hemodialysis. J Clin Med Pract 17(9):111–113 (article in Chinese)
11.
go back to reference Jiang N et al (2009) Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. Nephrol Dial Transplant 24(8):2551–2558CrossRefPubMed Jiang N et al (2009) Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. Nephrol Dial Transplant 24(8):2551–2558CrossRefPubMed
12.
go back to reference Chen W et al (2008) Effects of low-protein diet plus α-keto acid on micro-inflammation and the relationship between micro-inflammation and nutritional status in patients performing continuous ambulatory peritoneal dialysis: a randomized controlled trial. J Chin Integr Med 6(5):473–477CrossRef Chen W et al (2008) Effects of low-protein diet plus α-keto acid on micro-inflammation and the relationship between micro-inflammation and nutritional status in patients performing continuous ambulatory peritoneal dialysis: a randomized controlled trial. J Chin Integr Med 6(5):473–477CrossRef
13.
go back to reference Li H et al (2011) Effect of short-term low-protein diet supplemented with keto acids on hyperphosphatemia in maintenance hemodialysis patients. Blood Purif 31(1–3):33–40CrossRefPubMed Li H et al (2011) Effect of short-term low-protein diet supplemented with keto acids on hyperphosphatemia in maintenance hemodialysis patients. Blood Purif 31(1–3):33–40CrossRefPubMed
14.
go back to reference Chen J (2013) Nutrition, phosphorus, and keto-analogues in hemodialysis patients: a Chinese perspective. J Ren Nutr 23(3):214–217CrossRefPubMed Chen J (2013) Nutrition, phosphorus, and keto-analogues in hemodialysis patients: a Chinese perspective. J Ren Nutr 23(3):214–217CrossRefPubMed
15.
go back to reference Liyanage T et al (2015) Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 385(9981):1975–1982CrossRefPubMed Liyanage T et al (2015) Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 385(9981):1975–1982CrossRefPubMed
16.
go back to reference Murray CJ et al (2013) The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA 310(6):591–608CrossRefPubMed Murray CJ et al (2013) The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA 310(6):591–608CrossRefPubMed
17.
go back to reference Robinson BM et al (2016) Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. The Lancet 388(10041):294–306CrossRef Robinson BM et al (2016) Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. The Lancet 388(10041):294–306CrossRef
18.
go back to reference Muscaritoli M et al (2009) Malnutrition and wasting in renal disease. Curr Opin Clin Nutr Metab Care 12(4):378–383CrossRefPubMed Muscaritoli M et al (2009) Malnutrition and wasting in renal disease. Curr Opin Clin Nutr Metab Care 12(4):378–383CrossRefPubMed
19.
go back to reference Garibotto G et al (2010) Amino acid and protein metabolism in the human kidney and in patients with chronic kidney disease. Clin Nutr 29(4):424–433CrossRefPubMed Garibotto G et al (2010) Amino acid and protein metabolism in the human kidney and in patients with chronic kidney disease. Clin Nutr 29(4):424–433CrossRefPubMed
20.
go back to reference Malvy D et al (1999) Effects of severe protein restriction with ketoanalogues in advanced renal failure. J Am Coll Nutr 18(5):481–486CrossRefPubMed Malvy D et al (1999) Effects of severe protein restriction with ketoanalogues in advanced renal failure. J Am Coll Nutr 18(5):481–486CrossRefPubMed
21.
go back to reference Cianciaruso B et al (2008) Metabolic effects of two low protein diets in chronic kidney disease stage 4–5—a randomized controlled trial. Nephrol Dial Transplant 23(2):636–644CrossRefPubMed Cianciaruso B et al (2008) Metabolic effects of two low protein diets in chronic kidney disease stage 4–5—a randomized controlled trial. Nephrol Dial Transplant 23(2):636–644CrossRefPubMed
22.
go back to reference Bernard S et al (1996) Effects of low-protein diet supplemented with ketoacids on plasma lipids in adult chronic renal failure. Miner Electrolyte Metab 22(1–3):143–146PubMed Bernard S et al (1996) Effects of low-protein diet supplemented with ketoacids on plasma lipids in adult chronic renal failure. Miner Electrolyte Metab 22(1–3):143–146PubMed
24.
go back to reference Jiang N et al (2010) Improved plasma amino acids pattern following 12 months of supplemented low-protein diet in peritoneal dialysis patients. Ren Fail 32(6):709–715CrossRefPubMed Jiang N et al (2010) Improved plasma amino acids pattern following 12 months of supplemented low-protein diet in peritoneal dialysis patients. Ren Fail 32(6):709–715CrossRefPubMed
25.
go back to reference Jiang N et al (2011) Low-protein diet supplemented with keto acids is associated with suppression of small-solute peritoneal transport rate in peritoneal dialysis patients. Int J Nephrol 2011:542704CrossRefPubMedPubMedCentral Jiang N et al (2011) Low-protein diet supplemented with keto acids is associated with suppression of small-solute peritoneal transport rate in peritoneal dialysis patients. Int J Nephrol 2011:542704CrossRefPubMedPubMedCentral
26.
go back to reference Duenhas M et al (2013) Reduction of morbidity related to emergency access to dialysis with very low protein diet supplemented with ketoacids (VLPD + KA). Clin Nephrol 79(5):387–393CrossRefPubMed Duenhas M et al (2013) Reduction of morbidity related to emergency access to dialysis with very low protein diet supplemented with ketoacids (VLPD + KA). Clin Nephrol 79(5):387–393CrossRefPubMed
27.
go back to reference Shaman AM, Kowalski SR (2016) Hyperphosphatemia management in patients with chronic kidney disease. Saudi Pharm J 24(4):494–505CrossRefPubMed Shaman AM, Kowalski SR (2016) Hyperphosphatemia management in patients with chronic kidney disease. Saudi Pharm J 24(4):494–505CrossRefPubMed
28.
go back to reference David C et al (2016) Very low protein diets supplemented with keto-analogues in ESRD predialysis patients and its effect on vascular stiffness and AVF Maturation. BMC Nephrol 17(1):131CrossRefPubMedPubMedCentral David C et al (2016) Very low protein diets supplemented with keto-analogues in ESRD predialysis patients and its effect on vascular stiffness and AVF Maturation. BMC Nephrol 17(1):131CrossRefPubMedPubMedCentral
29.
go back to reference Dong J et al (2015) Ketoacid supplementation partially improves metabolic parameters in patients on peritoneal dialysis. Perit Dial Int 35(7):736–742CrossRefPubMedPubMedCentral Dong J et al (2015) Ketoacid supplementation partially improves metabolic parameters in patients on peritoneal dialysis. Perit Dial Int 35(7):736–742CrossRefPubMedPubMedCentral
30.
go back to reference Zhang YY, Huang J, Yang M, Gu LJ, Ji JY, Wang LJ, Yuan WJ (2015) Effect of a low-protein diet supplemented with keto-acids on autophagy and inflammation in 5/6 nephrectomized rats. Biosci Rep 35(5). doi:10.1042/BSR20150069 Zhang YY, Huang J, Yang M, Gu LJ, Ji JY, Wang LJ, Yuan WJ (2015) Effect of a low-protein diet supplemented with keto-acids on autophagy and inflammation in 5/6 nephrectomized rats. Biosci Rep 35(5). doi:10.​1042/​BSR20150069
31.
32.
go back to reference Piccoli GB et al (2014) Tailoring dialysis and resuming low-protein diets may favor chronic dialysis discontinuation: report on three cases. Hemodial Int 18(3):590–595CrossRefPubMed Piccoli GB et al (2014) Tailoring dialysis and resuming low-protein diets may favor chronic dialysis discontinuation: report on three cases. Hemodial Int 18(3):590–595CrossRefPubMed
Metadata
Title
Effect of restricted protein diet supplemented with keto analogues in end-stage renal disease: a systematic review and meta-analysis
Authors
Zheng Jiang
Yi Tang
Lichuan Yang
Xuhua Mi
Wei Qin
Publication date
01-04-2018
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 4/2018
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-017-1713-9

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