MO580HYPOPROTEIC DIET SUPPLEMENTED WITH KETOANALOGUES IN PATIENTS WITH ADVANCED DIABETIC KIDNEY DISEASE – EFFECTS ON MINERAL BONE DISORDERS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Liliana Garneata ◽  
Carmen-Antonia Mocanu ◽  
Tudor Petrisor Simionescu ◽  
Andreea Elena Mocanu ◽  
Gabriel Mircescu
Keyword(s):  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Serum Levels ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Diabetic Patients ◽  
Bone Disorders ◽  
Diabetic Kidney ◽  
Low Protein ◽  
Ckd Stage

Abstract Background and Aims Dietary protein restriction is rediscussed as mainstay approach in advanced Chronic Kidney Disease (CKD), both in diabetics and non-diabetics to defer renal replacement therapy (RRT), mainly by better metabolic control; improvements in mineral bone disorders (MBD) were also suggested, but less studied in Diabetic Kidney Disease (DKD). An unicentric prospective interventional trial aimed to assess the effects of ketoanalogue-supplemented low protein diet (sLPD) on proteinuria and CKD progression (data already presented). The parameters of MBD were also evaluated. Method Adult diabetic patients (452) with stable CKD stage 4+, proteinuria>3g/g creatininuria and SGA A were enrolled in a run-in phase (3 mo), with LPD (0.6g/kg dry ideal bw). Those who proved adherent (92, 64% males, median age 55.7 yrs, 65% on insulin) received sLPD (Ketosteril®, 1 tablet/10kg) for 12mo. Monitoring and treatment followed the Best Practice Guidelines. The primary endpoint was proteinuria during intervention as compared to pre-enrolment. Serum levels of calcium, phosphates and iPTH were considered to assess MBD. Nutrition, inflammation (SGA, BMI, serum albumin, CRP) and compliance were safety parameters. Results In patients with advanced DKD and severe proteinuria, sLPD was associated with a 69 (63; 82) % reduction in proteinuria (data presented). Significant amelioration in MBD was noted: serum levels of calcium and phosphates were significantly ameliorated at the end of the study as compared to enrolment - 4.3 (4.2-4.9) vs 3.2 (3.1-3.5) mg/dL and 5.4 (4.9-6.1) vs 8.2 (7.8-8.9) mg/dL, respectively. Serum iPTH significantly decreased: 185 (168-212) vs 375 (354-585) pg/mL. The need for calcium supplementation decreased: 6.5 (6.0-6.7) vs 7.0 (6.8-7.3) g/day. Vitamin D was required by only 35% vs 65% of patients. Nutritional status was preserved and dietary compliance was very good throughout the study. Conclusion In patients with advanced DKD ketoanalogue supplemented low protein diet seems to be effective and safe as part of MBD management.

scholarly journals Methionine abrogates the renoprotective effect of a low-protein diet against diabetic kidney disease in obese rats with type 2 diabetes

Aging ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 4489-4505 ◽  
Author(s):  
Munehiro Kitada ◽  
Yoshio Ogura ◽  
Itaru Monno ◽  
Jing Xu ◽  
Daisuke Koya
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Diabetic Kidney ◽  
Renoprotective Effect ◽  
Low Protein ◽  
Obese Rats

scholarly journals A Low-Protein Diet for Diabetic Kidney Disease: Its Effect and Molecular Mechanism, an Approach from Animal Studies

Nutrients ◽  
2018 ◽  
Vol 10 (5) ◽  
pp. 544 ◽  
Author(s):  
Munehiro Kitada ◽  
Yoshio Ogura ◽  
Itaru Monno ◽  
Daisuke Koya
Keyword(s):  
Kidney Disease ◽  
Molecular Mechanism ◽  
Animal Studies ◽  
Diabetic Kidney Disease ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Diabetic Kidney ◽  
Low Protein

scholarly journals Diabetic Kidney Disease Benefits from Intensive Low-Protein Diet: Updated Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Qiuling Li ◽  
Feng Wen ◽  
Yanhui Wang ◽  
Sheng Li ◽  
Shaochun Lin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Meta Analysis ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Diabetic Kidney ◽  
Low Protein

scholarly journals First, Do No Harm: Critical Appraisal of Protein Restriction for Diabetic Kidney Disease

Diabetology ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 51-64
Author(s):  
Satoru Yamada
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Protein Diet ◽  
Historical Background ◽  
Diabetic Patients ◽  
Protective Effects ◽  
Diabetic Kidney ◽  
Low Protein ◽  
Protein Diets

Low-protein diets have been recommended as diet therapy for the management of chronic kidney disease; however, its effect on chronic kidney disease has not been scientifically proven. Although several studies have reported significantly more favorable results with low-protein diet than with normal-protein diet, the renal protective effects of low-protein diets are still unclear in diabetic patients with chronic kidney disease. Moreover, some studies have reported that extremely low-protein diets may increase the risk of mortality. Thus, this paper describes the effectiveness and safety of low-protein diets for patients with diabetic kidney disease by reviewing the historical background of different low-protein diets that were critically examined in several studies.

scholarly journals SP400VERY LOW PROTEIN DIET REDUCES SERUM LEVELS OF INDOXYL SULFATE AND P-CRESYL SULFATE IN CHRONIC KIDNEY DISEASE

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii253-iii253 ◽  
Author(s):  
Maria Teresa Rocchetti ◽  
Carmela Cosola ◽  
Ighli di Bari ◽  
Lucia Di Micco ◽  
Emanuele De Simone ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Levels ◽  
Indoxyl Sulfate ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals The low-protein diet for chronic kidney disease: 8 years of clinical experience in a nephrology ward

2019 ◽  
Vol 13 (2) ◽  
pp. 253-260 ◽  
Author(s):  
Ivano Baragetti ◽  
Ilaria De Simone ◽  
Cecilia Biazzi ◽  
Laura Buzzi ◽  
Francesca Ferrario ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Independent Predictor ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein ◽  
Stage 4 ◽  
Ckd Stage ◽  
Severe Chronic Kidney Disease

Abstract Background Guidelines indicate that a low-protein diet (LPD) delays dialysis in severe chronic kidney disease (CKD). We assessed the value of these guidelines by performing a retrospective analysis in our renal clinical practice. Methods The analysis was performed from 1 January 2010 to 31 March 2018 in 299 CKD Stage 4 patients followed for 70 months in collaboration with a skilled nutritionist. The patients included 43 patients on a controlled protein diet (CPD) of 0.8 g/kg/day [estimated glomerular filtration rate (eGFR) 20–30 mL/min/1.73 m2 body surface (b.s.)], 171 patients on an LPD of 0.6 g/kg/day and 85 patients on an unrestricted protein diet (UPD) who were not followed by our nutritionist (LPD and UPD, eGFR <20 mL/min/1.73 m2 b.s.). Results eGFR was higher in CPD patients than in UPD and LPD patients (21.9 ± 7.4 mL/min/1.73 m2 versus 17.6 ± 8.00 mL/min/1.73 m2 and 17.1 ± 7.5 mL/min/1.73 m2; P = 0.008). The real daily protein intake was higher in UPD patients than in LPD and CDP patients (0.80 ± 0.1 g/kg/day versus 0.6 ± 0.2 and 0.63 ± 0.2 g/kg/day; P = 0.01). Body mass index (BMI) was stable in the LPD and CPD groups but decreased from 28.5 ± 4.52 to 25.4 ± 3.94 kg/m2 in the UPD group (P < 0.001). The renal survival of UPD, LPD and CPD patients was 47.1, 84.3 and 90.7%, respectively, at 30 months (P < 0.001), 42.4, 72.0 and 79.1%, respectively, at 50 months (P < 0.001) and 42.4, 64.1 and 74.4%, respectively, at 70 months (P < 0.001). The LPD patients started dialysis nearly 24 months later than the UPD patients. Diet was an independent predictor of dialysis [−67% of RR reduction (hazard ratio = 0.33; confidence interval 0.22–0.48)] together with a reduction in BMI. Conclusions An LPD recommended by nephrologists in conjunction with skilled dietitians delays dialysis and preserves nutritional status in severe CKD.

Elevated Serum Levels of Carbohydrate Antigen 72–4 in Diabetic Kidney Disease

2021 ◽  
Author(s):  
Lei Shi ◽  
Jiali Meng ◽  
Bin Zhang ◽  
Jiandong Chen ◽  
Jianzhong Chen ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Elevated Serum ◽  
Serum Levels ◽  
Carbohydrate Antigen ◽  
Urinary Albumin ◽  
Renal Diseases ◽  
Diabetic Patients ◽  
Healthy Controls ◽  
Diabetic Kidney

AbstractThe aim of this study was to determine whether carbohydrate antigen 72–4 (CA72–4) is elevated in diabetic kidney disease (DKD), and examine the association between urinary albumin-to-creatinine ratio (UACR) and CA72–4 in patients with type 2 diabetes mellitus (T2DM). Non-dialysis patients with T2DM (n=296) and 90 healthy controls were recruited in this study. CA72–4 level was measured by electrochemiluminescence immunoassay. DKD was defined as UACR≥ 30 mg/g in the absence of a urinary infection or other renal diseases. We found that patients with DKD had significantly higher serum CA72–4 levels compared to those with normoalbuminuria and healthy controls. Positive rates of CA72–4 increased gradually and markedly from normoalbuminuria to microalbuminuria and to macroalbuminuria in diabetic patients (7.5, 11.2, and 17.4%, respectively; P for trend< 0.05). CA72–4 also showed a positive correlation with UACR (r=0.288, P< 0.01). Logistic regression analysis revealed the association of increased UACR with an increased odds ratio of elevation of CA72–4 levels (P for trend< 0.05) after multivariable adjustment. In conclusion, serum levels of CA72–4 increase abnormally with the increase in urinary albumin excretion, which affects the specificity of diagnosis of malignancies. An appropriate interpretation of CA72–4 is essential to prevent unnecessary and even hazardous diagnostic procedures in patients with T2DM.

scholarly journals Safety and effectiveness of low-protein diet supplemented with ketoacids in diabetic patients with chronic kidney disease

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Vincenzo Bellizzi ◽  
Patrizia Calella ◽  
Julia Nava Hernández ◽  
Verónica Figueroa González ◽  
Silvia Moran Lira ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Diabetic Patients ◽  
Low Protein
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