Efficacy and safety of ketoanalogue supplementation combined with protein-restricted diets in advanced chronic kidney disease: a systematic review and meta-analysis

Tsai WC, Wu HY, Peng YS, Yang JY, Chen HY, Chiu YL et al (2017) Association of intensive blood pressure control and kidney disease progression in nondiabetic patients with chronic kidney disease: a systematic review and meta-analysis. JAMA Intern Med 177(6):792–799. https://doi.org/10.1001/jamainternmed.2017.0197

Article  PubMed  PubMed Central  Google Scholar 

Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V (2021) Chronic kidney disease. Lancet 398(10302):786–802. https://doi.org/10.1016/S0140-6736(21)00519-5

Article  PubMed  CAS  Google Scholar 

Lin JJ, Morey F, Wu HY, Yang JY, Peng YS, Mendez D et al (2021) Prevalence and risk factors for chronic kidney disease in belize: a population-based survey. Lancet Reg Health Am 1:100013. https://doi.org/10.1016/j.lana.2021.100013

Article  PubMed  PubMed Central  Google Scholar 

Sundstrom J, Bodegard J, Bollmann A, Vervloet MG, Mark PB, Karasik A et al (2022) Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2.4 million patients from 11 countries: the CaReMe CKD study. Lancet Reg Health Eur 20:100438. https://doi.org/10.1016/j.lanepe.2022.100438

Article  PubMed  PubMed Central  Google Scholar 

Chen IC, Tsai WC, Hsu LY, Ko MJ, Chien KL, Hung KY et al (2024) Association between alcohol consumption and chronic kidney disease: a population-based survey. Clin Exp Nephrol. https://doi.org/10.1007/s10157-024-02515-5

Article  PubMed  PubMed Central  Google Scholar 

Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W et al (2020) KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis 76(3 Suppl 1):S1–S107. https://doi.org/10.1053/j.ajkd.2020.05.006

Article  PubMed  CAS  Google Scholar 

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024) KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 105(4S):S117–S314. https://doi.org/10.1016/j.kint.2023.10.018

Article  Google Scholar 

Jiang Z, Zhang X, Yang L, Li Z, Qin W (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. https://doi.org/10.1007/s11255-015-1170-2

Article  PubMed  CAS  Google Scholar 

Li A, Lee HY, Lin YC (2019) The effect of ketoanalogues on chronic kidney disease deterioration: a meta-analysis. Nutrients 11(5):957. https://doi.org/10.3390/nu11050957

Article  PubMed  PubMed Central  CAS  Google Scholar 

Chewcharat A, Takkavatakarn K, Wongrattanagorn S, Panrong K, Kittiskulnam P, Eiam-Ong S et al (2020) The effects of restricted protein diet supplemented with ketoanalogue on renal function, blood pressure, nutritional status, and chronic kidney disease-mineral and bone disorder in chronic kidney disease patients: a systematic review and meta-analysis. J Ren Nutr 30(3):189–199. https://doi.org/10.1053/j.jrn.2019.07.005

Article  PubMed  CAS  Google Scholar 

Hahn D, Hodson EM, Fouque D (2020) Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev 10(10):CD001892. https://doi.org/10.1002/14651858.CD001892.pub5

Article  PubMed  Google Scholar 

Bellizzi V, Garofalo C, Ferrara C, Calella P (2022) Ketoanalogue supplementation in patients with non-dialysis diabetic kidney disease: a systematic review and meta-analysis. Nutrients 14(3):441. https://doi.org/10.3390/nu14030441

Article  PubMed  PubMed Central  CAS  Google Scholar 

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. Available from www.training.cochrane.org/handbook

Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898

Article  PubMed  Google Scholar 

Cohen J (1988) Statistical power analysis for the behavior sciences, 2nd edn. Lawrence Erlbaum Associates, New Jersey

Google Scholar 

Tsai WC, Wu HY, Peng YS, Hsu SP, Chiu YL, Chen HY et al (2018) Effects of lower versus higher phosphate diets on fibroblast growth factor-23 levels in patients with chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transplant 33(11):1977–1983. https://doi.org/10.1093/ndt/gfy005

Article  PubMed  CAS  Google Scholar 

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634. https://doi.org/10.1136/bmj.315.7109.629

Article  PubMed  PubMed Central  CAS  Google Scholar 

Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61(10):991–996. https://doi.org/10.1016/j.jclinepi.2007.11.010

Article  PubMed  Google Scholar 

Garneata L, Stancu A, Dragomir D, Stefan G, Mircescu G (2016) Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression. J Am Soc Nephrol 27(7):2164–2176. https://doi.org/10.1681/ASN.2015040369

Article  PubMed  PubMed Central  CAS  Google Scholar 

Bellizzi V, Signoriello S, Minutolo R, Di Iorio B, Nazzaro P, Garofalo C et al (2022) No additional benefit of prescribing a very low-protein diet in patients with advanced chronic kidney disease under regular nephrology care: a pragmatic, randomized, controlled trial. Am J Clin Nutr 115(5):1404–1417. https://doi.org/10.1093/ajcn/nqab417

Article  PubMed  CAS  Google Scholar 

Di Iorio BR, Minutolo R, De Nicola L, Bellizzi V, Catapano F, Iodice C et al (2003) Supplemented very low protein diet ameliorates responsiveness to erythropoietin in chronic renal failure. Kidney Int 64(5):1822–1828. https://doi.org/10.1046/j.1523-1755.2003.00282.x

Article  PubMed  Google Scholar 

Koppe L, Cassani de Oliveira M, Fouque D (2019) Ketoacid analogues supplementation in chronic kidney disease and future perspectives. Nutrients 11(9):2071. https://doi.org/10.3390/nu11092071

Article  PubMed  PubMed Central  CAS  Google Scholar 

Friedman AN, Fadem SZ (2010) Reassessment of albumin as a nutritional marker in kidney disease. J Am Soc Nephrol 21(2):223–230. https://doi.org/10.1681/ASN.2009020213

Article  PubMed  CAS  Google Scholar 

Menon V, Kopple JD, Wang X, Beck GJ, Collins AJ, Kusek JW et al (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):208–217. https://doi.org/10.1053/j.ajkd.2008.08.009

Article  PubMed  CAS  Google Scholar 

Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW et al (1994) The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of diet in renal disease study group. N Engl J Med 330(13):877–884. https://doi.org/10.1056/NEJM199403313301301

Article  PubMed  CAS  Google Scholar 

Aghwana R, Aiwuyo HO, Ovwasa H, Okoye O, Kweki AG, Unuigbe E (2023) Optimizing nutrition in renal patients: effects of a low-protein diet supplemented with ketoacids. Cureus 15(4):e38205. https://doi.org/10.7759/cureus.38205

Article  PubMed  PubMed Central  Google Scholar 

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):1249–1254. https://doi.org/10.1681/ASN.V1261249

Article  PubMed  Google Scholar 

Feiten SF, Draibe SA, Watanabe R, Duenhas MR, Baxmann AC, Nerbass FB et al (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):129–136. https://doi.org/10.1038/sj.ejcn.1602050

Article  PubMed  CAS  Google Scholar 

Khan IA, Nasiruddin M, Haque SF, Khan RA (2016) Comparative evaluation of efficacy and safety profile of rhubarb and alpha-keto analogs of essential amino acids supplementation in patients with diabetic nephropathy. Saudi J Kidney Dis Transpl 27(4):710–716. https://doi.org/10.4103/1319-2442.185227

Comments (0)

No login
gif