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International Urology and Nephrology

, Volume 48, Issue 3, pp 409–418 | Cite as

Effect of restricted protein diet supplemented with keto analogues in chronic kidney disease: a systematic review and meta-analysis

  • Zheng Jiang
  • Xiaoyan Zhang
  • Lichuan Yang
  • Zi Li
  • Wei QinEmail author
Nephrology - Original Paper

Abstract

Background

To evaluate the efficacy and safety of the restricted protein diet (low or very low protein diet) supplemented with keto analogues in the treatment of chronic kidney disease (CKD).

Methods

The Cochrane library, PubMed, Embase, CBM and CENTRAL databases were searched and reviewed up to April 2015. Clinical trials were analyzed using RevMan 5.3 software.

Results

Seven random control trials, one cross-over trial and one non-randomized concurrent control trial were selected and included in this study according to our inclusion and exclusion criteria. The changes of eGFR, BUN, Scr, albumin, PTH, triglyceride, cholesterol, calcium, phosphorus and nutrition indexes (BMI, lean body mass and mid-arm muscular circumference) before and after treatment were analyzed. The meta-analysis results indicated that, comparing with normal protein diet, low protein diet (LPD) or very low protein diet (vLPD) supplemented with keto analogues (s(v)LPD) could significantly prevent the deterioration of eGFR (P < 0.001), hyperparathyroidism (P = 0.04), hypertension (P < 0.01) and hyperphosphatemia (P < 0.001). No differences in BUN, Scr, Albumin, triglyceride, cholesterol, hemoglobin, calcium and nutrition indexes were observed between different protein intake groups.

Conclusion

Restricted protein diet supplemented with keto analogues (s(v)LPD) could delay the progression of CKD effectively without causing malnutrition.

Keywords

Restricted protein diet Keto analogues Chronic kidney disease Meta-analysis Systematic review 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Aparicio M, Bellizzi V, Chauveau P, Cupisti A, Ecder T, Fouque D, Garneata L, Lin S, Mitch WE, Teplan V, Zakar G, Yu X (2012) Keto acid therapy in predialysis chronic kidney disease patients: final consensus. J Ren Nutr 22(2 Suppl):S22–S24CrossRefPubMedGoogle Scholar
  2. 2.
    Garneata L, Mircescu G (2013) Effect of low-protein diet supplemented with keto acids on progression of chronic kidney disease. J Ren Nutr 23(3):210–213CrossRefPubMedGoogle Scholar
  3. 3.
    Malvy D, Maingourd C, Pengloan J, Bagros P, Nivet H (1999) Effects of severe protein restriction with ketoanalogues in advanced renal failure. J Am Coll Nutr 18(5):481–486CrossRefPubMedGoogle Scholar
  4. 4.
    Mircescu G, Garneata L, Stancu SH, Capusa C (2007) Effects of a supplemented hypoproteic diet in chronic kidney disease. J Ren Nutr 17(3):179–188CrossRefPubMedGoogle Scholar
  5. 5.
    Prakash S, Pande DP, Sharma S, Sharma D, Bal CS, Kulkarni H (2004) Randomized, double-blind, placebo-controlled trial to evaluate efficacy of ketodiet in predialytic chronic renal failure. J Ren Nutr 14(2):89–96CrossRefPubMedGoogle Scholar
  6. 6.
    Qiu HY, Liu F, Zhao LJ, Huang SM, Zuo C, Zhong H, Chen F (2012) Comparison of the effects of alpha-keto/amino acid supplemented low protein diet and diabetes diet in patients with diabetic nephropathy. Sichuan Da Xue Xue Bao Yi Xue Ban 43(3):425–428PubMedGoogle Scholar
  7. 7.
    Teplan V, Schuck O, Racek J, Mareckova O, Stollova M, Hanzal V, Maly J (2008) Reduction of plasma asymmetric dimethylarginine in obese patients with chronic kidney disease after three years of a low-protein diet supplemented with keto-amino acids: a randomized controlled trial. Wien Klin Wochenschr 120(15–16):478–485CrossRefPubMedGoogle Scholar
  8. 8.
    Bellizzi V, Di Iorio BR, De Nicola L, Minutolo R, Zamboli P, Trucillo P, Catapano F, Cristofano C, Scalfi L, Conte G (2007) Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney Int 71(3):245–251CrossRefPubMedGoogle Scholar
  9. 9.
    Hecking E, Andrzejewski L, Prellwitz W, Opferkuch W, Muller D (1980) Double-blind cross-over study with oral alpha-ketoacids in patients with chronic renal failure. Am J Clin Nutr 33(7):1678–1681PubMedGoogle Scholar
  10. 10.
    Feiten SF, Draibe SA, Watanabe R, Duenhas MR, Baxmann AC, Nerbass FB, Cuppari L (2005) Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients. Eur J Clin Nutr 59(1):129–136CrossRefPubMedGoogle Scholar
  11. 11.
    Bernhard J, Beaufrere B, Laville M, Fouque D (2001) Adaptive response to a low-protein diet in predialysis chronic renal failure patients. J Am Soc Nephrol 12(6):1249–1254PubMedGoogle Scholar
  12. 12.
    Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, Chen M, He Q, Liao Y, Yu X, Chen N, Zhang J-E, Hu Z, Liu F, Hong D, Ma L, Liu H, Zhou X, Chen J, Pan L, Chen W, Wang W, Li X, Wang H (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822CrossRefPubMedGoogle Scholar
  13. 13.
    Fouque D, Aparicio M (2007) Eleven reasons to control the protein intake of patients with chronic kidney disease. Nat Clin Pract Nephrol 3(7):383–392CrossRefPubMedGoogle Scholar
  14. 14.
    Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH (2002) Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int 62(1):220–228CrossRefPubMedGoogle Scholar
  15. 15.
    Chang JH, Kim DK, Park JT, Kang EW, Yoo TH, Kim BS, Choi KH, Lee HY, Han DS, Shin SK (2009) Influence of ketoanalogs supplementation on the progression in chronic kidney disease patients who had training on low-protein diet. Nephrology (Carlton) 14(8):750–757CrossRefGoogle Scholar
  16. 16.
    Levey AS, Greene T, Sarnak MJ, Wang X, Beck GJ, Kusek JW, Collins AJ, Kopple JD (2006) Effect of dietary protein restriction on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease (MDRD) study. Am J Kidney Dis 48(6):879–888CrossRefPubMedGoogle Scholar
  17. 17.
    Menon V, Kopple JD, Wang X, Beck GJ, Collins AJ, Kusek JW, Greene T, Levey AS, Sarnak MJ (2009) Effect of a very low-protein diet on outcomes: long-term follow-up of the modification of diet in renal disease (MDRD) study. Am J Kidney Dis 53(2):208–217CrossRefPubMedGoogle Scholar
  18. 18.
    Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, Kuhlmann MK, Stenvinkel P, TerWee P, Teta D, Wang AY, Wanner C (2013) Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the international society of renal nutrition and metabolism. Kidney Int 84(6):1096–1107CrossRefPubMedGoogle Scholar
  19. 19.
    Kovesdy CP (2013) Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr 2013(97):1163–1177CrossRefGoogle Scholar
  20. 20.
    Kalantar-Zadeh K, Tortorici AR, Chen JL, Kamgar M, Lau WL, Moradi H, Rhee CM, Streja E, Kovesdy CP (2015) Dietary restrictions in dialysis patients: is there anything left to eat? Semin Dial 28(2):159–168CrossRefPubMedGoogle Scholar
  21. 21.
    Chauveau P, Barthe N, Rigalleau V, Ozenne S, Castaing F, Delclaux C, de Precigout V, Combe C, Aparicio M (1999) Outcome of nutritional status and body composition of uremic patients on a very low protein diet. Am J Kidney Dis 34(3):500–507CrossRefPubMedGoogle Scholar
  22. 22.
    Aparicio M, Chauveau P, De Precigout V, Bouchet JL, Lasseur C, Combe C (2000) Nutrition and outcome on renal replacement therapy of patients with chronic renal failure treated by a supplemented very low protein diet. J Am Soc Nephrol 11(4):708–716PubMedGoogle Scholar
  23. 23.
    Kovesdy CP, Kopple JD, Kalantar-Zadeh K (2013) Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr 97(6):1163–1177PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Shah AP, Kalantar-Zadeh K, Kopple JD (2015) Is there a role for ketoacid supplements in the management of CKD? Am J Kidney Dis 65(5):659–673CrossRefPubMedGoogle Scholar
  25. 25.
    Moorthi R (2011) CKD-mineral and bone disorder: core curriculum 2011. Am J Kidney Dis 58(6):1022–1036PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Moe SM, Zidehsarai MP, Chambers MA, Jackman LA, Radcliffe JS, Trevino LL, Donahue SE, Asplin JR (2011) Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol 6(2):257–264PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Lindenau K, Abendroth K, Kokot F, Vetter K, Rehse C, Frohling PT (1990) Therapeutic effect of keto acids on renal osteodystrophy. A prospective controlled study. Nephron 55(2):133–135CrossRefPubMedGoogle Scholar
  28. 28.
    Di Iorio B, Di Micco L, Torraca S, Sirico ML, Russo L, Pota A, Mirenghi F, Russo D (2012) Acute effects of very-low-protein diet on FGF23 levels: a randomized study. Clin J Am Soc Nephrol 7(4):581–587CrossRefPubMedGoogle Scholar
  29. 29.
    Chauveau P, Combe C, Rigalleau V, Vendrely B, Aparicio M (2007) Restricted protein diet is associated with decrease in proteinuria: consequences on the progression of renal failure. J Ren Nutr 17(4):250–257CrossRefPubMedGoogle Scholar
  30. 30.
    Teplan V, Schuck O, Knotek A, Hajny J, Horackova M, Kvapil M (2003) Enhanced metabolic effect of erythropoietin and keto acids in CRF patients on low-protein diet: Czech multicenter study. Am J Kidney Dis 41(3 Suppl 1):S26–S30CrossRefPubMedGoogle Scholar
  31. 31.
    Di Iorio BR, Minutolo R, De Nicola L, Bellizzi V, Catapano F, Iodice C, Rubino R, Conte G (2003) Supplemented very low protein diet ameliorates responsiveness to erythropoietin in chronic renal failure. Kidney Int 64(5):1822–1828CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Zheng Jiang
    • 1
  • Xiaoyan Zhang
    • 1
  • Lichuan Yang
    • 2
  • Zi Li
    • 2
  • Wei Qin
    • 2
    Email author
  1. 1.West China School of MedicineSichuan UniversityChengduChina
  2. 2.Division of Nephrology, Department of MedicineWest China Hospital of Sichuan UniversityChengduChina

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