Keto-supplemented low protein diet: A valid therapeutic approach for patients with steroid-resistant proteinuria during early-stage chronic kidney disease


Background and objectives

Low protein diets supplemented with keto acid (sLPD) are recommended for patients with stage 3–5 chronic kidney disease (CKD). This study assessed whether sLPD is beneficial for patients with steroid-resistant proteinuria during early-stage CKD.

Design, setting, participants, and measurements

A 1-year randomized controlled trial was conducted from 2010 to 2012. In this study, 108 proteinuric patients who were steroid-resistant were assigned to a sLPD group (0.6 g/kg/d with 0.09 g/kg/d keto acids) or a normal protein diet group (NPD, 1.0 g/kg/d). Estimated dietary protein intake, urinary protein excretion, remission rate, renal function, nutritional status, and blood pressure were measured.


Baseline characteristics were comparable between the sLPD group (47 patients) and the NPD group (49 patients). Urinary protein excretion significantly decreased in sLPD compared to NPD in months 6, 9, and 12 (P<0.05). Proteinuria reduction was higher in sLPD than in NPD (P<0.001) at the end of the study. Complete remission and partial remission rates were higher in sLPD than in NPD. Serum albumin and pre-albumin levels were higher in sLPD than in NPD in months 9 and 12 (P<0.05). Serum total cholesterol and triglyceride levels declined more significantly in sLPD than in NPD (P<0.01) at the end of the study. There were no differences in nutritional status, renal function, hemoglobin, or blood pressure between the two groups.


sLPD is both nutritionally safe and beneficial, providing nephroprotective effects for early-stage CKD patients with steroid-resistant proteinuria.

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Correspondence to Hongli Lin.

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Zhang, J., Xie, H., Fang, M. et al. Keto-supplemented low protein diet: A valid therapeutic approach for patients with steroid-resistant proteinuria during early-stage chronic kidney disease. J Nutr Health Aging 20, 420–427 (2016).

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Key words

  • Chronic kidney disease
  • dietary protein intake
  • nephroprotection
  • renal function