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.

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 Plant-Based versus Animal-Based Low Protein Diets in the Management of Chronic Kidney Disease

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3721
Author(s):  
Carmen-Antonia Mocanu ◽  
Tudor Petrisor Simionescu ◽  
Andreea Elena Mocanu ◽  
Liliana Garneata
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Salt Intake ◽  
Saturated Fatty Acids ◽  
Pressure Control ◽  
High Ratio ◽  
Diabetic Patients ◽  
Low Protein ◽  
Kidney Replacement Therapy ◽  
Protein Diets

Recent data reiterate low-protein diets (LPDs) as cornerstones in the conservative management of chronic kidney disease (CKD). The reduction in proteinuria, better blood pressure control and the reduction in the rate of decline in kidney function with LPDs were reported, both in non-diabetics and diabetics patients. Supplemented, vegetarian, very-low-protein diets (sVLPD, 0.3 g/kg-day) could postpone kidney replacement therapy (KRT) initiation, mainly through the better control of metabolic disorders of advanced CKD in non-diabetic patients. Plant-based diets could ameliorate gut microbiota and appear to be superior to mixed hypoproteic diets in treating advanced CKD: better control of nitrogen balance, acid-base metabolism and bone mineral disorders. Vegetarian diets generate fewer uremic toxins and reduce salt intake and acid overload. At the same time, they can improve lipid metabolism, providing a high ratio of unsaturated to saturated fatty acids, as well as insulin resistance.

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

Hypoadiponectinemia is associated with aortic stiffness in nondialysis diabetic patients with stage 3–5 chronic kidney disease

Vascular ◽  
2021 ◽  
pp. 170853812110076
Author(s):  
Ssu-Chin Lin ◽  
Tsung-Jui Wu ◽  
Du-An Wu ◽  
Bang-Gee Hsu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Aortic Stiffness ◽  
Diabetic Kidney Disease ◽  
Applanation Tonometry ◽  
Serum Adiponectin ◽  
Control Group ◽  
Multivariable Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Diabetic Kidney

Objectives Albuminuria and serum adiponectin levels are factors that have been associated with the development of cardiovascular disease in patients with diabetes mellitus. Here we investigated the relationship between serum adiponectin levels and aortic stiffness in nondialysis diabetic kidney disease patients with stage 3–5 chronic kidney disease. Methods Fasting blood samples were obtained from 80 nondialysis diabetic kidney disease patients with stage 3–5 chronic kidney disease. Carotid-femoral pulse wave velocity (cfPWV) was measured using applanation tonometry; cfPWV values of >10 m/s were defined as aortic stiffness. Serum adiponectin levels were determined by enzyme immunoassay. Results Forty-two patients (52.5%) with nondialysis diabetic kidney disease were diagnosed with aortic stiffness. The patients in this group were older ( p =  0.011), had higher systolic blood pressure ( p =  0.002) and urine albumin-to-creatinine ratios ( p =  0.013), included fewer females ( p =  0.024), and had lower serum adiponectin ( p =  0.001) levels than those in the control group. Multivariable logistic regression analysis revealed that serum adiponectin was independently associated with aortic stiffness (odds ratio = 0.930, 95% confidence interval: 0.884–0.978, p =  0.005) and also positively correlated with cfPWV values by multivariable linear regression ( β = –0.309, p =  0.002) in nondialysis diabetic kidney disease patients. Conclusions The results suggested that serum adiponectin levels could be used to predict aortic stiffness in nondialysis diabetic kidney disease patients with stage 3–5 chronic kidney disease.

scholarly journals Prevalence and risk factors of diabetic kidney disease in north eastern Nigeria

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Ijuptil Chiroma ◽  
Mohammad Maina Sulaiman ◽  
Bilkisu Mohammed Mubi ◽  
Akilahyel Auta Ndahi ◽  
Ahidiyu Anaryu Mamza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Stage Iv ◽  
Diabetic Patients ◽  
Diabetic Kidney ◽  
North Eastern ◽  
Male Sex ◽  
Stage Renal Disease

Diabetic Kidney Disease (DKD) is a leading cause of chronic kidney disease and end stage renal disease. In northeastern Nigeria the epidemiology and risk factors have not been fully studied. This study aimed at evaluating the prevalence and risk factors of DKD in Maiduguri, north eastern Nigeria. The study population consisted of adult diabetic patients recruited consecutively at the diabetic clinic of University of Maiduguri Teaching Hospital Maiduguri. Socio-demographic variables including age, sex, weight, BMI, as well as laboratory parameters, were obtained from each patient. Glomerular filtration rate was derived from CKD-EPI formula using serum creatinine. Two hundred and sixty-one diabetic patients were recruited. The prevalence of DKD among them was 42.9%. Classification based on eGFRshowed that 35(13.4%) patients had hyperfiltration; 48 (18.4%) stage I; 66 (25.3%) stage II; 68 (26.1%) stage III; 36 (13.8%) stage IV; 8 (3.1%) stage V. One hundred and seventeen (44.8%) had proteinuria. Low eGFR <60ml/1.73M2 was associated with age >50 years (r=1.039, p=0.011); male sex (r=-0.899, p=0.008); hyperuricaemia (r=1.010, p=0.000); low PCV (r=1.276, p=0.000); HbA1C (r=1.127, p=0.030); proteinuria (r=2.011, p=0.004).This study has shown that chronic kidney disease is common among diabetic patients in northeastern Nigeria. Age, male sex, hyperuricaemia, low PCV, high HbA1C levels and proteinuria were found to be associated with development of DKD.

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