Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis?

Background: Previous studies have demonstrated that dietary therapy can delay the initiation of dialysis, but little research has investigated whether patients with very poor renal function would benefit from a dietary therapy. Methods: This study was performed by using the Chang Gung Research Database (CGRD), which is based on the largest medical system in Taiwan. Patients with estimated glomerular filtration rates (eGFR) < 15 mL/min/1.73 m2 between 2001 and 2015 with more than 3 months of low-protein diet supplemented with ketoanalogues (sLPD) were extracted (Ketosteril group). We then assigned five patients without any sLPD to match one patient of the Ketosteril group (comparison group). Both groups were followed up for 1 year for the initiation of dialysis and rates of major adverse cardiac and cerebrovascular events (MACCEs). Results: The Ketosteril group (n = 547), compared with the comparison group (n = 2735), exhibited a lower incidence of new-onset dialysis (40.2% vs. 44.4%, subdistribution hazard ratio (SHR): 0.80, 95% confidence interval (CI): 0.70–0.91) and MACCEs (3.7% vs. 5.9%, HR: 0.61, 95% CI: 0.38–0.97). The beneficial effect of an sLPD did not differ in patients with a baseline eGFR < 5 mL/min/1.73 m2. Conclusion: Even among patients with extremely low eGFR, sLPD treatment can safely delay the need for dialysis.

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Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study

Nutrients ◽

10.3390/nu10081035 ◽

2018 ◽

Vol 10 (8) ◽

pp. 1035 ◽

Cited By ~ 5

Author(s):

Chieh-Li Yen ◽

Kun-Hua Tu ◽

Ming-Shyan Lin ◽

Su-Wei Chang ◽

Pei-Chun Fan ◽

...

Keyword(s):

Protein Diet ◽

Low Protein Diet ◽

Research Database ◽

Negative Consequences ◽

Term Survival ◽

Low Protein ◽

All Cause Mortality ◽

Stage Renal Disease ◽

End Stage

Background: A beneficial effect of a ketoanalogue-supplemented low-protein diet (sLPD) in postponing dialysis has been demonstrated in numerous previous studies. However, evidence regarding its effect on long-term survival is limited. Our study assessed the long-term outcomes of patients on an sLPD after commencing dialysis. Methods: This retrospective study examined patients with new-onset end-stage renal disease with permanent dialysis between 2001 and 2013, extracted from Taiwan’s National Health Insurance Research Database. Patients who received more than 3 months of sLPD treatment in the year preceding the start of dialysis were extracted. The outcomes studied were all-cause mortality, infection rate, and major cardiac and cerebrovascular events (MACCEs). Results: After propensity score matching, the sLPD group (n = 2607) showed a lower risk of all-cause mortality (23.1% vs. 27.6%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.70–0.84), MACCEs (19.2% vs. 21.5%, HR 0.86, 95% CI 0.78–0.94), and infection-related death (9.9% vs. 12.5%, HR 0.76, 95% CI 0.67–0.87) than the non-sLPD group did. Conclusion: We found that sLPD treatment might be safe without long-term negative consequences after dialysis treatment.

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Long-Term Effects of Ketoanalogues on Mortality and Renal Outcomes in Advanced Chronic Kidney Disease Patients Receiving a Low-Protein Diet

Nutrients ◽

10.3390/nu12092708 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2708

Author(s):

Yi-Chun Wang ◽

Shu-Hui Juan ◽

Chu-Lin Chou ◽

Tsung-Cheng Hsieh ◽

Jung-Lun Wu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Protein Diet ◽

Low Protein Diet ◽

Research Database ◽

Long Term Effects ◽

Low Protein ◽

Significant Difference ◽

Patients With Diabetes

The effects of ketoanalogues (KA) supplementation on mortality and progression to dialysis in patients with pre-dialysis stage 5 chronic kidney disease (CKD) receiving a low-protein diet (LPD) remain ambiguous. From Taiwan’s National Health Insurance Research Database during 1996–2011, 165 patients with pre-dialysis CKD on an LPD (0.6 g/kg/day) with KA supplementation were matched with 165 patients with pre-dialysis CKD on an LPD without KA supplementation. Of the 165 patients with advanced CKD receiving KA supplementation, 34 (20.6%) died, and 124 (75.2%) underwent long-term dialysis during the study period. There was no significant difference in mortality between the KA-user group and the KA-nonuser group (adjusted hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.68–2.93; p = 0.355). KA supplementation significantly increased long-term dialysis risk (adjusted HR, 1.41; 95% CI, 1.04–1.90; p = 0.025) and combined outcome risk (defined as long-term dialysis and death; adjusted HR, 1.37; 95% CI, 1.02–1.83; p = 0.034). KA supplementation also increased long-term dialysis risk (adjusted HR, 1.49; 95% CI, 1.00–2.20; p = 0.048) in the subgroup of pre-dialysis patients with diabetes mellitus (DM), but not in those patients without DM. In conclusion, KA supplementation might increase long-term dialysis risk in patients with advanced CKD receiving an LPD, but it did not increase mortality.

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Supplemented Low-Protein Diet May Delay the Need for Preemptive Kidney Transplantation: A Nationwide Population-Based Cohort Study

Nutrients ◽

10.3390/nu13093002 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3002

Author(s):

Chieh-Li Yen ◽

Pei-Chun Fan ◽

George Kuo ◽

Chao-Yu Chen ◽

Ya-Lien Cheng ◽

...

Keyword(s):

Cohort Study ◽

Kidney Transplantation ◽

Adverse Events ◽

Population Based ◽

Protein Diet ◽

Low Protein Diet ◽

Research Database ◽

Post Transplantation ◽

Low Protein ◽

Preemptive Kidney Transplantation

Background: Although several studies suggest the benefit of a low-protein diet supplemented with amino acids and keto acids (sLPD) in delaying the initiation of hemodialysis, evidence on whether these nutritional approaches could delay the timing of preemptive transplantation is lacking. Methods: Retrospective nationwide cohort study, from Taiwan’s National Health Insurance Research Database. Patients having undergone a first preemptive kidney transplantation between 2001 and 2017 were identified and divided into two groups according to the presence of sLPD treatment or not. The primary outcome was the time between the diagnosis of advanced CKD and transplantation. Secondary outcomes were post-transplantation adverse events. Results: A total of 245 patients who received their first preemptive kidney transplantation were identified from the nationwide database; 63 of them had been on an sLPD prior to transplantation (sLPD group). The duration between the day of advanced CKD diagnosis and the day of transplantation was significantly longer in the sLPD group compared with the non-sLPD group (median duration: 345 vs. 220 days, p = 0.001). The risk of post-transplantation adverse events did not differ between the two groups. Conclusions: Within the limits of its observational, retrospective design, this is the first study to suggest that nutritional management with sLPDs can safely delay the timing of preemptive kidney transplantation.

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Hepatic Ultrastructure Changes Induced by Lithocholic Acid

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100060829 ◽

1967 ◽

Vol 25 ◽

pp. 162-163 ◽

Cited By ~ 1

Author(s):

F. G. Zaki

Keyword(s):

Endoplasmic Reticulum ◽

Lithocholic Acid ◽

Smooth Endoplasmic Reticulum ◽

Protein Diet ◽

Low Protein Diet ◽

Electron Microscopic ◽

Hydropic Degeneration ◽

Hepatic Cells ◽

Low Protein ◽

Microscopic Studies

Addition of lithocholic acid (LCA), a naturally occurring bile acid in mammals, to a low protein diet fed to rats induced marked inflammatory reaction in the hepatic cells followed by hydropic degeneration and ductular cell proliferation. These changes were accompanied by dilatation and hyperplasia of the common bile duct and formation of “gallstones”. All these changes were reversible when LCA was withdrawn from the low protein diet except for the hardened gallstones which persisted.Electron microscopic studies revealed marked alterations in the hepatic cells. Early changes included disorganization, fragmentation of the rough endoplasmic reticulum and detachment of its ribosomes. Free ribosomes, either singly or arranged in small clusters were frequently seen in most of the hepatic cells. Vesiculation of the smooth endoplasmic reticulum was often encountered as early as one week after the administration of LCA (Fig. 1).

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Ernährung bei chronisch Nierenkranken – Wie kann man eine Low-Protein-Diet erreichen?

Dialyse aktuell ◽

10.1055/s-0035-1555716 ◽

2015 ◽

Vol 19 (05) ◽

pp. 256-256

Keyword(s):

Protein Diet ◽

Low Protein Diet ◽

Low Protein

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Project report: the effect of maternal low protein diet on the neuromuscular system of the offspring in mice

10.36866/pn.101.11 ◽

2016 ◽

pp. 11-11

Author(s):

Ifigeneia Giakoumaki

Keyword(s):

Protein Diet ◽

Low Protein Diet ◽

Neuromuscular System ◽

Project Report ◽

Low Protein

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Economic Effects of Treatment of Chronic Kidney Disease with Low-Protein Diet

SSRN Electronic Journal ◽

10.2139/ssrn.2338432 ◽

2013 ◽

Author(s):

Francesco Saverio Mennini ◽

Simone Russo ◽

Andrea Marcellusi ◽

Giuseppe Quintaliani ◽

Denis Fouque

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Economic Effects ◽

Protein Diet ◽

Low Protein Diet ◽

Low Protein

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PSIV-6 Effect of a Phytogenic Water Additive on Growth Performance, Blood Metabolites and Gene Expression of Amino Acids Transporters in Nursery Pigs Fed with Low Protein Diets

Journal of Animal Science ◽

10.1093/jas/skaa278.507 ◽

2020 ◽

Vol 98 (Supplement_4) ◽

pp. 281-282

Author(s):

Cedrick N Shili ◽

Mohammad Habibi ◽

Julia Sutton ◽

Jessie Barnes ◽

Jacob Burchkonda ◽

...

Keyword(s):

Gene Expression ◽

Amino Acids ◽

Growth Performance ◽

Mrna Abundance ◽

Protein Diet ◽

Low Protein Diet ◽

Blood Calcium ◽

Low Protein ◽

Protein Diets ◽

Standard Protein

Abstract Moderately low protein (MLP) diets can help decrease nutrient excretion from the swine production. However, MLP diets negatively impact growth performance. We hypothesized that supplementing MLP diets with phytogenics may reduce the negative effects of these diets on growth. The objective of this study was to investigate the effect of a phytogenic water additive (PWA; Herbanimal®) on growth performance, blood metabolite and gene expression of amino acids transporters in pigs fed with MLP diets. Forty-eight weaned barrows were allotted to six dietary treatments (n = 8) for 4 weeks: >CON-NS: standard protein diet-no PWA; CON-LS: standard protein diet-low PWA dose (4 ml/L); CON-HS: standard protein diet-high PWA dose (8 ml/L); LP-NS: low protein diet-no PWA; LP-LS: low protein diet-low PWA dose (4 ml/L); LP-HS: low protein diet- high PWA dose (8 ml/L). Feed intake and body weight were recorded daily and weekly, respectively. At week 4, blood and tissue samples were collected and analyzed for metabolites using a chemistry analyzer and amino acid transporters using qPCR, respectively. The data were analyzed by univariate GLM (SPSS®) and the means were separated using paired Student’s t-test corrected by Benjamini-Hochberg. Pigs fed CON-HS improved the average daily gain and serum calcium and phosphorus concentrations compared to CON-NS. Pigs fed LP-LS had higher serum phosphorus and blood urea nitrogen compared to the pigs fed with LP-NS. The mRNA abundance of SLC7A11 in the jejunum was lower in CON-LS and CON-HS compared to CON-NS. Additionally, mRNA abundance of SLC6A19 in the jejunum of pigs fed with LP-LS was higher compared to LP-NS and lower in CON-HS relative to pigs fed with CON-LS. In conclusion, PWA improved the growth performance of pigs fed standard protein diets but not low protein diets. Further, the PWA improved the concentrations of blood calcium and phosphorous in pigs fed MLP diets. Funding: Agrivida and Animal Health and Production and Animal Products: Improved Nutritional Performance, Growth, and Lactation of Animals from the USDA-NIFA.

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