Skip to main content
SpringerLink
Log in

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

  • Nephrology - Review
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Imai E, Matsuo S (2008) Chronic kidney disease in Asia. The Lancet 371(9631):2147–2148

    Article  Google Scholar 

  2. Kovesdy CP, Kalantar-Zadeh K (2012) Enter the dragon: a Chinese epidemic of chronic kidney disease? The Lancet 379(9818):783–785

    Article  Google Scholar 

  3. Zhang L et al (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822

    Article  PubMed  Google Scholar 

  4. 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

    Google Scholar 

  5. Wanner C, Amann K, Shoji T (2016) The heart and vascular system in dialysis. Lancet 388(10041):276–284

    Article  PubMed  Google Scholar 

  6. Sabatino A et al (2017) Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clin Nutr 36(3):663–671

    Article  CAS  PubMed  Google Scholar 

  7. 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):71–77

    Article  CAS  PubMed  Google Scholar 

  8. 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):409–418

    Article  CAS  PubMed  Google Scholar 

  9. 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)

    Google Scholar 

  10. 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)

    CAS  Google Scholar 

  11. 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):2551–2558

    Article  CAS  PubMed  Google Scholar 

  12. 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):473–477

    Article  CAS  Google Scholar 

  13. 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):33–40

    Article  PubMed  Google Scholar 

  14. Chen J (2013) Nutrition, phosphorus, and keto-analogues in hemodialysis patients: a Chinese perspective. J Ren Nutr 23(3):214–217

    Article  CAS  PubMed  Google Scholar 

  15. Liyanage T et al (2015) Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 385(9981):1975–1982

    Article  PubMed  Google Scholar 

  16. Murray CJ et al (2013) The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA 310(6):591–608

    Article  CAS  PubMed  Google Scholar 

  17. 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):294–306

    Article  Google Scholar 

  18. Muscaritoli M et al (2009) Malnutrition and wasting in renal disease. Curr Opin Clin Nutr Metab Care 12(4):378–383

    Article  CAS  PubMed  Google Scholar 

  19. 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):424–433

    Article  CAS  PubMed  Google Scholar 

  20. Malvy D et al (1999) Effects of severe protein restriction with ketoanalogues in advanced renal failure. J Am Coll Nutr 18(5):481–486

    Article  CAS  PubMed  Google Scholar 

  21. 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):636–644

    Article  CAS  PubMed  Google Scholar 

  22. 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):143–146

    CAS  PubMed  Google Scholar 

  23. Kalantar-Zadeh K et al (2015) Dietary restrictions in dialysis patients: is there anything left to eat? Semin Dial 28(2):159–168

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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):709–715

    Article  CAS  PubMed  Google Scholar 

  25. 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 2011:542704

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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):387–393

    Article  CAS  PubMed  Google Scholar 

  27. Shaman AM, Kowalski SR (2016) Hyperphosphatemia management in patients with chronic kidney disease. Saudi Pharm J 24(4):494–505

    Article  PubMed  Google Scholar 

  28. 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):131

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dong J et al (2015) Ketoacid supplementation partially improves metabolic parameters in patients on peritoneal dialysis. Perit Dial Int 35(7):736–742

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. 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. Attini R et al (2016) Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience. BMC Nephrol 17(1):132

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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):590–595

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Zheng Jiang

  2. West China School of Medicine, Sichuan University, Chengdu, Sichuan, China

    Zheng Jiang

  3. Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Yi Tang, Lichuan Yang, Xuhua Mi & Wei Qin

Authors
  1. Zheng Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lichuan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xuhua Mi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Wei Qin planned the study, analyzed data and assisted in article preparation. Zheng Jiang and Yi Tang searched the literature, selected articles, extracted data, analyzed data and composed the article. Lichuan Yang and Xuhua Mi contributed to the concept, data collection and analysis of this study.

Corresponding author

Correspondence to Wei Qin.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, Z., Tang, Y., Yang, L. et al. Effect of restricted protein diet supplemented with keto analogues in end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol 50, 687–694 (2018). https://doi.org/10.1007/s11255-017-1713-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-017-1713-9

Keywords

Search

Navigation