1
|
Kosmadakis G, Necoara A, Fuentes F, Ramade N, Baudenon J, Deville C, Enache I, Gueret C, Haskour A. Beneficial Effects of Ketoanalogues on the Evolution of Renal Function and Bone Mineral Disorders in Patients with Advanced Chronic Kidney Disease: A Pilot Study. ANNALS OF NUTRITION & METABOLISM 2024:1-8. [PMID: 39033751 DOI: 10.1159/000540472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION The supplementation with Ketoanalogues in patients on very low-protein diets has shown a favorable effect on the evolution of renal function. The aim of the present study was to evaluate the progression of renal function in advanced chronic kidney disease patients on a low-protein diet (<0.8 g/kg/d) with or without additional Ketoanalogues. METHODS The primary criterion is the evolution of the renal function at 6, 12, and 24 months for the two groups. The secondary criteria comprise the evolution of the body weight, mean blood pressure, 24-h proteinuria, salt and protein consumption, energy consumption, hemoglobin levels, serum albumin, prealbumin, C-reactive protein, liver function tests, serum electrolyte and phosphate levels, parathormone as well as calcium levels at the same time periods. RESULTS There was a significant nephroprotective effect of the Ketoanalogues after 12 and 24 months with no differences in the protein consumption between the two groups. Mean blood pressure, hemoglobin levels, 24-hour proteinuria, serum electrolyte, liver function tests, salt and protein consumption, and serum albumin and prealbumin did not present any significant differences. Serum bicarbonate and calcium levels were higher while serum phosphate and parathormone levels were lower in the Ketoanalogue group at all follow-up time points. During the 24-month follow-up period, 4 patients from the Ketoanalogue group and 8 patients from the control group quit the study. CONCLUSION A low-protein diet supplemented with Ketoanalogues exerts significant nephroprotective effects and better bone mineral metabolism parameters compared to a low-protein diet only.
Collapse
|
2
|
Kundu S, Hossain KS, Moni A, Zahan MS, Rahman MM, Uddin MJ. Potentials of ketogenic diet against chronic kidney diseases: pharmacological insights and therapeutic prospects. Mol Biol Rep 2022; 49:9749-9758. [PMID: 35441940 DOI: 10.1007/s11033-022-07460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a worldwide public health concern. Nutritional interventions become a primary concern in managing various diseases, including CKD. Ketogenic diets (KD) are a popular diet and an increasingly used diet for weight loss. MAIN BODY With the increasing cases of CKD, KD has been proposed as a treatment by many scientists. Several studies have shown that KD can slow down the progression rate of renal abnormalities. Also, this diet is regarded as a safe route for managing CKD. CKD is generally associated with increased inflammation, oxidative stress, fibrosis, autophagy dysfunction, and mitochondrial dysfunction, while all of these can be attenuated by KD. The protective effect of KD is mainly mediated through inhibition of ROS, NF-κB, and p62 signaling. CONCLUSIONS It is suggested that KD could be considered a new strategy for managing and treating CKD more carefully. This review explores the potential of KD on CKD and the mechanism involved in KD-mediated kidney protection.
Collapse
Affiliation(s)
- Sushmita Kundu
- ABEx Bio-Research Center, East Azampur, Dhaka, 1230, Bangladesh
| | | | - Akhi Moni
- ABEx Bio-Research Center, East Azampur, Dhaka, 1230, Bangladesh
| | - Md Sarwar Zahan
- ABEx Bio-Research Center, East Azampur, Dhaka, 1230, Bangladesh
| | - Md Masudur Rahman
- Department of Pathology, Faculty of Veterinary, Animal and Biomedical Sciences, Sylhet Agricultural University, Sylhet, 3100, Bangladesh
| | - Md Jamal Uddin
- ABEx Bio-Research Center, East Azampur, Dhaka, 1230, Bangladesh. .,Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, 03760, Republic of Korea.
| |
Collapse
|
3
|
Ketoanalogue Supplementation in Patients with Non-Dialysis Diabetic Kidney Disease: A Systematic Review and Meta-Analyses. Nutrients 2022; 14:nu14030441. [PMID: 35276799 PMCID: PMC8838123 DOI: 10.3390/nu14030441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/17/2023] Open
Abstract
The effects of supplemental ketoanalogues (KA) in patients with diabetic kidney disease (DKD) are not well characterized. Several databases for peer-reviewed articles were systematically searched to identify studies reporting outcomes associated with the effects of a low-protein diet (LPD) or very-low protein diet (VLPD) in combination with supplemental KA in adults with DKD. Meta-analyses were conducted when feasible. Of 213 identified articles, 11 could be included in the systematic review. Meta-analyses for renal outcomes (4 studies examining glomerular filtration rate; 5 studies examining 24-h urinary protein excretion), metabolic outcomes (5 studies examining serum urea; 7 studies examining blood glucose), clinical outcomes (6 studies examining blood pressure; 4 studies examining hemoglobin), and nutritional outcomes (3 studies examining serum albumin; 4 studies examining body weight) were all in favor of KA use in DKD patients. Data from individual studies that examined other related parameters also tended to show favorable effects from KA-supplemented LPD/VLPD. The regimens were safe and well tolerated, with no evidence of adverse effects on nutritional status. In conclusion, LPD/VLPD supplemented with KA could be considered effective and safe for patients with non-dialysis dependent DKD. Larger studies are warranted to confirm these observations.
Collapse
|
4
|
Asghari G, Teymoori F, Farhadnejad H, Mirmiran P, Azizi F. Dietary Amino Acid Patterns Are Associated With Incidence of Chronic Kidney Disease. J Ren Nutr 2021; 32:312-318. [PMID: 34053818 DOI: 10.1053/j.jrn.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/18/2021] [Accepted: 04/17/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES No findings are available regarding the association of the dietary amino acid (AA) intakes with the risk of chronic kidney disease (CKD) in adults. We aimed to assess the association between dietary AA patterns and incidence of CKD in adults. DESIGN AND METHODS This study was conducted within the framework of Tehran Lipid and Glucose Study on 4,233 adults, who were free of CKD at baseline (2009-2011) and were followed for 3.1 years (2011-2014). The principal component analysis was used based on 8 AA groups to characterize major AA patterns. Multivariable logistic regression models were used to estimate the risk of CKD across quartiles of dietary AA pattern scores. RESULTS Three major AA patterns were extracted: (1) higher loads of branched-chain, alcoholic, and aromatic AAs; (2) higher loads of acidic AAs, proline, and lower load of alkaline AAs and small AAs; and (3) higher loads of sulfuric AAs and small AAs. The mean ± standard deviation age of participants (45.9% male) was 39.4 ± 11.7 at baseline and the incidence of CKD was 12.1% (513 cases) after 3.1 years of follow-up. The highest score of first dietary AA pattern tended to be associated with an increased risk of CKD (odds ratio = 1.43, 95% confidence interval1.06-1.93); however, the second pattern was related to a decreased risk of CKD (odds ratio = 0.71, 95% confidence interval: 0.52-0.97) in the multivariable model. CONCLUSION These novel findings suggest that the dietary AA patterns may modify risk of CKD.
Collapse
Affiliation(s)
- Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Teymoori
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Hossein Farhadnejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Ottka C, Vapalahti K, Määttä A, Huuskonen N, Sarpanen S, Jalkanen L, Lohi H. High serum creatinine concentration is associated with metabolic perturbations in dogs. J Vet Intern Med 2021; 35:405-414. [PMID: 33349961 PMCID: PMC7848334 DOI: 10.1111/jvim.16011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The kidneys have many essential metabolic functions, and metabolic disturbances during decreased renal function have not been studied extensively. OBJECTIVES To identify metabolic changes in blood samples with increased serum creatinine concentration, indicating decreased glomerular filtration. ANIMALS Clinical samples analyzed using a nuclear magnetic resonance (NMR) based metabolomics platform. The case group consisted of 23 samples with serum creatinine concentration >125 μmol/L, and the control group of 873 samples with serum creatinine concentration within the reference interval. METHODS Biomarker association with increased serum creatinine concentration was evaluated utilizing 3 statistical approaches: Wilcoxon rank-sum test, logistic regression analysis (false discovery rate (FDR)-corrected P-values), and random forest classification. Medians of the biomarkers were compared to reference intervals. A heatmap and box plots were used to represent the differences. RESULTS All 3 statistical approaches identified similar analytes associated with increased serum creatinine concentrations. The percentages of citrate, tyrosine, branched-chain amino acids, valine, leucine, albumin, linoleic acid and the ratio of phenylalanine to tyrosine differed significantly using all statistical approaches, acetate differed using the Wilcoxon test and random forest, docosapentaenoic acid percentage only using logistic regression (P < .05), and alanine only using random forest. CONCLUSIONS AND CLINICAL IMPORTANCE We identified several metabolic changes associated with increased serum creatinine concentrations, including prospective diagnostic markers and therapeutic targets. Further research is needed to verify the association of these changes with the clinical state of the dog. The NMR metabolomics test is a promising tool for improving diagnostic testing and management of renal diseases in dogs.
Collapse
Affiliation(s)
- Claudia Ottka
- PetMeta Labs LtdHelsinkiFinland
- Department of Veterinary BiosciencesUniversity of HelsinkiHelsinkiFinland
- Department of Medical and Clinical GeneticsUniversity of HelsinkiHelsinkiFinland
- Folkhälsan Research CenterHelsinkiFinland
| | - Katariina Vapalahti
- PetMeta Labs LtdHelsinkiFinland
- Department of Veterinary BiosciencesUniversity of HelsinkiHelsinkiFinland
- Department of Medical and Clinical GeneticsUniversity of HelsinkiHelsinkiFinland
- Folkhälsan Research CenterHelsinkiFinland
| | | | | | | | | | - Hannes Lohi
- PetMeta Labs LtdHelsinkiFinland
- Department of Veterinary BiosciencesUniversity of HelsinkiHelsinkiFinland
- Department of Medical and Clinical GeneticsUniversity of HelsinkiHelsinkiFinland
- Folkhälsan Research CenterHelsinkiFinland
| |
Collapse
|
6
|
Bolasco P. Hemodialysis-Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses be the Sharpest "Sword of Damocles"? Nutrients 2020; 12:nu12061773. [PMID: 32545868 PMCID: PMC7353226 DOI: 10.3390/nu12061773] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
This review aims to highlight the strengths and weaknesses emerging from diagnostic evaluations and prescriptions in an intent to prevent progression over time of malnutrition and/or protein-energy wasting (PEW) in hemodialysis (HD) patients. In particular, indications of the most effective pathway to follow in diagnosing a state of malnutrition are provided based on a range of appropriate chemical-clinical, anthropometric and instrumental analyses and monitoring of the nutritional status of HD patients. Finally, based on the findings of recent studies, therapeutic options to be adopted for the purpose of preventing or slowing down malnutrition have been reviewed, with particular focus on protein-calorie intake, the role of oral and/or intravenous supplements and efficacy of some classes of amino acids. A new determining factor that may lead inexorably to PEW in hemodialysis patients is represented by severe amino acid loss during hemodialysis sessions, for which mandatory compensation should be introduced.
Collapse
Affiliation(s)
- Piergiorgio Bolasco
- Nephrology Consultant, Sardinian Regional Public Health Institution, 09047 Selargius, Italy; ; Tel.: +39-333-2914-844; Fax: +39-070-609-3240
- Chronic Kidney Disease Treatment Group of the Italian Society of Nephrology, University Street, 11, 00185 Rome, Italy
| |
Collapse
|
7
|
McNulty MA, Goupil BA, Albarado DC, Castaño-Martinez T, Ambrosi TH, Puh S, Schulz TJ, Schürmann A, Morrison CD, Laeger T. FGF21, not GCN2, influences bone morphology due to dietary protein restrictions. Bone Rep 2019; 12:100241. [PMID: 31921941 PMCID: PMC6950640 DOI: 10.1016/j.bonr.2019.100241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/12/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Dietary protein restriction is emerging as an alternative approach to treat obesity and glucose intolerance because it markedly increases plasma fibroblast growth factor 21 (FGF21) concentrations. Similarly, dietary restriction of methionine is known to mimic metabolic effects of energy and protein restriction with FGF21 as a required mechanism. However, dietary protein has been shown to be required for normal bone growth, though there is conflicting evidence as to the influence of dietary protein restriction on bone remodeling. The purpose of the current study was to evaluate the effect of dietary protein and methionine restriction on bone in lean and obese mice, and clarify whether FGF21 and general control nonderepressible 2 (GCN2) kinase, that are part of a novel endocrine pathway implicated in the detection of protein restriction, influence the effect of dietary protein restriction on bone. Methods Adult wild-type (WT) or Fgf21 KO mice were fed a normal protein (18 kcal%; CON) or low protein (4 kcal%; LP) diet for 2 or 27 weeks. In addition, adult WT or Gcn2 KO mice were fed a CON or LP diet for 27 weeks. Young New Zealand obese (NZO) mice were placed on high-fat diets that provided protein at control (16 kcal%; CON), low levels (4 kcal%) in a high-carbohydrate (LP/HC) or high-fat (LP/HF) regimen, or on high-fat diets (protein, 16 kcal%) that provided methionine at control (0.86%; CON-MR) or low levels (0.17%; MR) for up to 9 weeks. Long bones from the hind limbs of these mice were collected and evaluated with micro-computed tomography (μCT) for changes in trabecular and cortical architecture and mass. Results In WT mice the 27-week LP diet significantly reduced cortical bone, and this effect was enhanced by deletion of Fgf21 but not Gcn2. This decrease in bone did not appear after 2 weeks on the LP diet. In addition, Fgf21 KO mice had significantly less bone than their WT counterparts. In obese NZO mice dietary protein and methionine restriction altered bone architecture. The changes were mediated by FGF21 due to methionine restriction in the presence of cystine, which did not increase plasma FGF21 levels and did not affect bone architecture. Conclusions This study provides direct evidence of a reduction in bone following long-term dietary protein restriction in a mouse model, effects that appear to be mediated by FGF21.
Collapse
Affiliation(s)
- Margaret A. McNulty
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, LA 70803, USA
- Corresponding author at: Department of Anatomy, Cell Biology, & Physiology
| | - Brad A. Goupil
- Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, LA 70803, USA
| | | | - Teresa Castaño-Martinez
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
| | - Thomas H. Ambrosi
- Department of Adipocyte Development and Nutrition, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
- Department of Surgery, Stanford Medicine, Stanford, CA 94305, USA
| | - Spela Puh
- Department of Adipocyte Development and Nutrition, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - Tim J. Schulz
- German Center for Diabetes Research, München-Neuherberg, Germany
- Department of Adipocyte Development and Nutrition, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam-Rehbrücke, Germany
| | - Annette Schürmann
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam-Rehbrücke, Germany
| | | | - Thomas Laeger
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
- Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
| |
Collapse
|
8
|
Wang SY, Cai GY, Chen XM. Energy restriction in renal protection. Br J Nutr 2018; 120:1149-1158. [PMID: 30401006 PMCID: PMC6316363 DOI: 10.1017/s0007114518002684] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 07/22/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023]
Abstract
Energy restriction (ER) has been widely studied as a novel intervention, and its ability to prolong life has been fully demonstrated. For example, ER can significantly extend the lifespans of model flies, worms, rodents and other mammals. The role of ER in renal protection has also been elucidated. In preclinical studies, adjusting total energy intake or consumption of specific nutrients has prophylactic or therapeutic effects on ageing-related kidney disease and acute and chronic kidney injury. Amino acid restriction has gradually attracted attention. ER mimetics have also been studied in depth. The protective mechanisms of ER and ER mimetics for renal injury include increasing AMP-activated protein kinase and sirtuin type 1 (Sirt1) levels and autophagy and reducing mammalian target of rapamycin, inflammation and oxidative stress. However, the renal protective effect of ER has mostly been investigated in rodent models, and the role of ER in patients cannot be determined due to the lack of large randomised controlled trials. To protect the kidney, the mechanism of ER must be thoroughly researched, and more accurate diet or drug interventions need to be identified.
Collapse
Affiliation(s)
| | - Guang-Yan Cai
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese PLA Institute of Nephrology, Chinese PLA General Hospital, Beijing 100853, People’s Republic of China
| | | |
Collapse
|
9
|
Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study. Nutrients 2018; 10:nu10081035. [PMID: 30096785 PMCID: PMC6115816 DOI: 10.3390/nu10081035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/20/2022] Open
Abstract
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.
Collapse
|
10
|
Nutritional treatment of advanced CKD: twenty consensus statements. J Nephrol 2018; 31:457-473. [PMID: 29797247 PMCID: PMC6061255 DOI: 10.1007/s40620-018-0497-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/04/2018] [Indexed: 12/12/2022]
Abstract
The Italian nephrology has a long tradition and experience in the field of dietetic-nutritional therapy (DNT), which is an important component in the conservative management of the patient suffering from a chronic kidney disease, which precedes and integrates the pharmacological therapies. The objectives of DNT include the maintenance of an optimal nutritional status, the prevention and/or correction of signs, symptoms and complications of chronic renal failure and, possibly, the delay in starting of dialysis. The DNT includes modulation of protein intake, adequacy of caloric intake, control of sodium and potassium intake, and reduction of phosphorus intake. For all dietary-nutritional therapies, and in particular those aimed at the patient with chronic renal failure, the problem of patient adherence to the dietetic-nutritional scheme is a key element for the success and safety of the DNT and it can be favored by an interdisciplinary and multi-professional approach of information, education, dietary prescription and follow-up. This consensus document, which defines twenty essential points of the nutritional approach to patients with advanced chronic renal failure, has been written, discussed and shared by the Italian nephrologists together with representatives of dietitians (ANDID) and patients (ANED).
Collapse
|
11
|
Bellizzi V, Calella P, Hernández JN, González VF, Lira SM, Torraca S, Arronte RU, Cirillo P, Minutolo R, Montúfar Cárdenas RA. Safety and effectiveness of low-protein diet supplemented with ketoacids in diabetic patients with chronic kidney disease. BMC Nephrol 2018; 19:110. [PMID: 29743031 PMCID: PMC5944089 DOI: 10.1186/s12882-018-0914-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 05/02/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The impact of the low-protein diet on nutrition in CKD diabetics is uncertain. METHODS The metabolic and nutritional effects of a low-protein (0.5-0.6 g/kg/d), normal-high energy (30-35 kcal/kg/d) diet supplemented with ketoacids (LPD-KA) were prospectively evaluated in CKD patients with (DM) and without (non-DM) diabetes mellitus. RESULTS 197 patients on CKD stages 3-5 were enrolled. DM (n = 81) and non-DM (n = 116) were comparable for gender (Male 58 vs 55%), age (66 ± 9 vs 63 ± 18 years), renal function (eGFR 23 ± 13 vs 24 ± 13 mL/min). After 6-month, serum urea (DM: 131 ± 58 to 105 ± 49 mg/dl, p < 0.05; non-DM: 115 ± 52 to 88 ± 36, p < 0.05) and phosphate (DM: 4.5 ± 1.3 to 4.1 ± 1.2 mg/dl, p = 0.06; non-DM: 4.3 ± 1.0 to 3.7 ± 0.8, p < 0.05) declined. Fasting glucose decreased in DM (126 ± 52 to 103 ± 29 mg/dl, p < 0.05) without insulin dose increase. These effects were preserved after 3-year. Serum albumin did not change after 6 months (DM: 3.7 ± 0.6 to 3.8 ± 0.4 mg/dl; non-DM: 4.0 ± 0.6 to 4.0 ± 0.4) and in the long-term. Body weight (BW) declined after the diet start (DM: 68.9 ± 14.3 to 65.1 ± 12.1 kg, p < 0.05; non-DM: 66.6 ± 15.1 to 64.1 ± 15.1, p < 0.05) and was stable at 6 months and 3 years. Muscle strength at baseline was reduced in all patients and remained stable during the diet period. Changes of nutritional markers during the study were similar among groups and diabetes was not associated to any nutritional change at the multivariate analysis. As attain wasting, lower BMI (< 23 kg/m2) and albumin (< 3.8 g/dl) levels were present in 1/3 patients at start and along 3 years, cholesterol never dropped below the lower threshold (< 100 mg/dl) and poorer FM (< 10%) was less than 10% during the study in both groups. CONCLUSIONS In diabetic CKD patients a low-protein diet supplemented with ketoacids improves uremia and diabetes, causes sudden decline of body weight which remains stable over time and has not a negative effect on wasting and muscle mass and fitness. In diabetic CKD patients the LPD-KA is safe and the nutritional impact is the same as in non-diabetics CKD.
Collapse
Affiliation(s)
- Vincenzo Bellizzi
- Division of Nephrology, Dialysis and Transplantation, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84131, Salerno, Italy.
| | - Patrizia Calella
- Department of Movement and Wellness Sciences, University of Naples Parthenope, Naples, Italy
| | | | | | - Silvia Moran Lira
- Centro de Atención Nutricional Fresenius Kabi, Ciudad de México, Mexico
| | - Serena Torraca
- Division of Nephrology, Dialysis and Transplantation, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84131, Salerno, Italy
| | | | - Pietro Cirillo
- Division of Nephrology, University Hospital Policlinico di Bari, Bari, Italy
| | - Roberto Minutolo
- Division of Nephrology, University of Campania, Luigi Vanvitelli, Napoli, Italy
| | | |
Collapse
|
12
|
Low-protein diet supplemented with ketoacids delays the progression of diabetic nephropathy by inhibiting oxidative stress in the KKAy mice model. Br J Nutr 2017; 119:22-29. [PMID: 29208058 DOI: 10.1017/s0007114517003208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diabetic nephropathy (DN) is a major cause of chronic kidney disease. We aimed to investigate the effect of the low-protein diets (LPD) supplemented with ketoacids (LPD+KA) in KKAy mice, an early type 2 DN model. KKAy mice were treated with normal protein diet (NPD), LPD or LPD+KA from 12 to 24 weeks of age. A period of 12-week treatment with LPD significantly reduced albuminuria as compared with that observed after NPD treatment. Treatment with LPD+KA further reduced albuminuria as compared with that observed with LPD treatment alone. Moreover, LPD treatment reduced mesangial expansion, thickness of glomerular basement membrane and the severity of the podocyte foot process effacement in KKAy mice; these effects were more pronounced in KKAy mice treated with LPD+KA. Both LPD and LPD+KA treatments slightly reduced total body weight, but had no significant effect on kidney weight and blood glucose concentrations when compared with NPD-treated KKAy mice. LPD treatment slightly attenuated oxidative stress in kidneys as compared with that observed in NPD-treated KKAy mice; however, LPD+KA treatment remarkably ameliorated oxidative stress in diabetic kidneys as shown by decreased malondialdehyde concentrations, protein carbonylation, nitrotyrosine expression and increased superoxide dismutase expression. Nutritional therapy using LPD+KA confers additional renal benefits as compared with those of LPD treatment alone in early type 2 DN through inhibition of oxidative stress.
Collapse
|
13
|
Nava J, Moran S, Figueroa V, Salinas A, Lopez M, Urbina R, Gutierrez A, Lujan JL, Orozco A, Montufar R, Piccoli GB. Successful pregnancy in a CKD patient on a low-protein, supplemented diet: an opportunity to reflect on CKD and pregnancy in Mexico, an emerging country. J Nephrol 2017; 30:877-882. [PMID: 28918595 DOI: 10.1007/s40620-017-0428-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022]
Abstract
Pregnancy is probably the most important challenge in young women with chronic kidney disease (CKD). The challenge is greater in developing countries, in which access to dialysis is uneven, and prenatal care for CKD patients is not uniformly available. This case report summarizes some of the challenges faced by pregnant CKD women in a developing country. A 35-year-old woman, affected by an undiagnosed kidney disease, experienced preeclampsia at 24 years of age, and started dialysis in emergency at age 31 in the context of severe preeclampsia in her second pregnancy. Following slow recovery of kidney function, after 18 months of dialysis she started a moderately restricted, supplemented, low-protein diet, which allowed her to discontinue dialysis. A few months after dialysis discontinuation, she started a new pregnancy in the presence of severely reduced kidney function (serum creatinine 4.6 mg/dl at the last pre-pregnancy control). Interestingly, she discontinued nephrology and nutritional follow-up, mainly because she was worried that she would be discouraged from continuing the pregnancy, but also because she continued to feel well. She self-managed her diet in pregnancy and delivered a healthy baby, with normal intrauterine growth, at term; while the last laboratory data confirmed the presence of severe kidney function impairment, she is still dialysis-free at the time of the present report. Her story, with its happy ending, underlines the importance of dedicated programs for CKD pregnancies in developing countries and confirms the safety of moderately protein-restricted diets in pregnancy.
Collapse
Affiliation(s)
- Julia Nava
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Silvia Moran
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Veronica Figueroa
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Adriana Salinas
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Margy Lopez
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Rocio Urbina
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Abril Gutierrez
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Jose Luis Lujan
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Alejandra Orozco
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPER), Calle Montes Urales 800, Ciudad de Mexico, Mexico
| | - Rafael Montufar
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico.
| | - Giorgina B Piccoli
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy.
- Nephrologie, Centre Hospitalier Le Mans, Avenue Roubillard, 72000, Le Mans, France.
| |
Collapse
|
14
|
Metzger M, Yuan WL, Haymann JP, Flamant M, Houillier P, Thervet E, Boffa JJ, Vrtovsnik F, Froissart M, Bankir L, Fouque D, Stengel B. Association of a Low-Protein Diet With Slower Progression of CKD. Kidney Int Rep 2017; 3:105-114. [PMID: 29340320 PMCID: PMC5762958 DOI: 10.1016/j.ekir.2017.08.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 06/21/2017] [Accepted: 08/07/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction Reducing protein intake is recommended for slowing chronic kidney disease (CKD) progression, but assessment of its true effectiveness is sparse. Methods Using the Maroni formula, we assessed dietary protein intake (DPI) from 24-hour urinary urea excretion in 1594 patients (67% men and 33% women) with CKD, 784 of whom also had 7-day food records. Cause-specific hazard ratios (HRs) and 95% confidence intervals for the competing risks of DPI-associated end-stage renal disease (ESRD) or death were estimated in 1412 patients with baseline glomerular filtration rate ≥15 ml/min per 1.73 m2, measured by 51Cr-EDTA renal clearance (mGFR). Results Overall, mean DPI estimated from urea excretion was 1.09 ± 0.30 g/kg of body weight per day (range = 0.34-2.76); 20% of patients had values > 1.3 g/kg per day, and 1.9% had values < 0.6 g/kg per day. Urea excretion and food records produced similar estimates of mean DPI. The lower the mGFR, the lower the mean DPI. Over a median follow-up of 5.6 years, there were 319 ESRD events and 189 pre-ESRD deaths. After adjusting for relevant covariates, each 0.1 g/kg daily higher baseline urea excretion-based DPI or food record-based DPI was associated with an HR for ESRD of 1.05 (95% confidence interval 1.01-1.10) or 1.09 (95% confidence interval 1.04-1.14), respectively. HRs were stronger in patients with baseline mGFR < 30 ml/min per 1.73 m2. There was no association with mortality. The mean age of the patients was 59 ± 15 years, and mean body mass index was 26.6 ± 5.2 kg/m2. Conclusion In this prospective observational study, the lower the baseline DPI, the slower the progression toward ESRD. Most importantly, the absence of threshold for the relation between DPI and ESRD risk indicates that there is no optimal DPI in the range observed in this cohort.
Collapse
Affiliation(s)
- Marie Metzger
- Centre de recherches en Epidémiologie et Santé des Populations, Inserm, University of Paris-Sud, University of Versailles Saint-Quentin, University of Paris-Saclay, Villejuif, France
| | - Wen Lun Yuan
- Centre des Sciences du Goût et de l’Alimentation, Centre National de la Recherche Scientifique, Institut National de la Recherche Agronomique, University of Bourgogne Franche-Comté, Dijon, France
- Centre de Recherche Épidémiologie et Statistique Sorbonne, Inserm, University of Paris-Descartes, Villejuif, France
| | - Jean-Philippe Haymann
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
- Inserm Unité mixte de recherche scientifique, 1155, University Pierre et Marie-Curie, Paris, France
| | - Martin Flamant
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Centre de Recherche sur l’Inflammation, Inserm, Université Paris-Diderot, Paris, France
| | - Pascal Houillier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Inserm Unité mixte de recherche scientifique, 1138, Centre de Recherche des Cordeliers, Paris, 75006, France
- University Paris Descartes, Paris, France
| | - Eric Thervet
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Paris Centre de Recherche Cardiovasculaire, Inserm, University of Paris-Descartes, Paris, France
| | - Jean-Jacques Boffa
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
- Inserm Unité mixte de recherche scientifique, 1155, University Pierre et Marie-Curie, Paris, France
| | - François Vrtovsnik
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Centre de Recherche sur l’Inflammation, Inserm, Université Paris-Diderot, Paris, France
| | - Marc Froissart
- Centre de recherches en Epidémiologie et Santé des Populations, Inserm, University of Paris-Sud, University of Versailles Saint-Quentin, University of Paris-Saclay, Villejuif, France
- Centre hospitalier universitaire vaudois/University of Lausanne, Centre de Recherche Clinique, Lausanne, Switzerland
| | - Lise Bankir
- Inserm Unité mixte de recherche scientifique, 1138, Centre de Recherche des Cordeliers, Paris, 75006, France
| | - Denis Fouque
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
- Laboratoire Cardiovasculaire, Métabolisme, Diabétologie et Nutrition, Unité mixte de recherche scientifique, 1060, Inserm, University Lyon-Sud, Oullins, France
| | - Bénédicte Stengel
- Centre de recherches en Epidémiologie et Santé des Populations, Inserm, University of Paris-Sud, University of Versailles Saint-Quentin, University of Paris-Saclay, Villejuif, France
- Correspondence: Bénédicte Stengel, Inserm U1018, CESP, Team 5, 16, avenue P. Vaillant Couturier, F-94807, Villejuif, France.Inserm U1018CESPTeam 5, 16, avenue P. Vaillant Couturier, F-94807VillejuifFrance
| |
Collapse
|
15
|
Wu CH, Yang YW, Hung SC, Kuo KL, Wu KD, Wu VC, Hsieh TC. Ketoanalogues supplementation decreases dialysis and mortality risk in patients with anemic advanced chronic kidney disease. PLoS One 2017; 12:e0176847. [PMID: 28475591 PMCID: PMC5419544 DOI: 10.1371/journal.pone.0176847] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/18/2017] [Indexed: 12/20/2022] Open
Abstract
Background The benefit of alpha-Ketoanalogues (KA) supplementation for chronic kidney disease (CKD) patients that followed low-protein diet (LPD) remains undetermined. Methods We extracted longitudinal data for all CKD patients in the Taiwan National Health Insurance from January 1, 2000 through December 31, 2010. A total of 1483 patients with anemic advanced CKD treated with LPD, who started KA supplementation, were enrolled in this study. We analyzed the risks of end stage renal disease and all-cause mortality using Cox proportional hazard models with influential drugs as time-dependent variables. Results A total of 1113 events of initiating long-term dialysis and 1228 events of the composite outcome of long-term dialysis or death occurred in patients with advanced CKD after a mean follow-up of 1.57 years. Data analysis suggests KA supplementation is associated with a lower risk for long-term dialysis and the composite outcome when daily dosage is more than 5.5 tablets. The beneficial effect was consistent in subgroup analysis, independent of age, sex, and comorbidities. Conclusions Among advanced CKD patients that followed LPD, KA supplementation at an appropriate dosage may substantially reduce the risk of initiating long-term dialysis or of developing the composite outcome. KA supplementation represents an additional therapeutic strategy to slow the progression of CKD.
Collapse
Affiliation(s)
- Che-Hsiung Wu
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ya-Wen Yang
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Kwan-Dun Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (VW); (T-CH)
| | - Tsung-Cheng Hsieh
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- * E-mail: (VW); (T-CH)
| | | |
Collapse
|
16
|
Kiuchi A, Ohashi Y, Tai R, Aoki T, Mizuiri S, Ogura T, Aikawa A, Sakai K. Association between Low Dietary Protein Intake and Geriatric Nutrition Risk Index in Patients with Chronic Kidney Disease: A Retrospective Single-Center Cohort Study. Nutrients 2016; 8:E662. [PMID: 27782097 PMCID: PMC5084048 DOI: 10.3390/nu8100662] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/07/2016] [Accepted: 10/14/2016] [Indexed: 12/14/2022] Open
Abstract
Reduced dietary protein intake in malnourished patients with chronic kidney disease (CKD) may be associated with adverse clinical outcomes, which may mask any efficacy of a low-protein diet. The study included 126 patients with CKD who attended a dedicated dietary counseling clinic in 2005-2009 and were systematically followed until January 2015. Of these patients, 20 (15.9%) had moderate or severe nutrition-related risk of geriatric nutritional risk index (GNRI) < 92; these patients were more likely to be older, have a greater proteinuria, and have lower body mass index and serum albumin concentration. Dietary protein intake was significantly lower in older patients (r = -0.33, p < 0.001) and those with lower glomerular filtration rate (r = 0.47, p < 0.001). The non-protein to nitrogen calorie ratio was independently associated with GNRI. Reduced GNRI was significantly associated with mortality (hazard ratio (HR) = 4.94; 95% confidence interval (CI) = 1.61-15.42, p = 0.012) and cardiovascular events (HR = 9.37; 95% CI = 2.49-37.34, p = 0.006), but not with adverse renal outcomes. Restricting protein intake may be harmful to patients with any nutrition-related risk, suggesting that improvement of nutritional status should be a high priority.
Collapse
Affiliation(s)
- Aki Kiuchi
- Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan.
| | - Yasushi Ohashi
- Department of Nephrology, Sakura Medical Center, School of Medicine, Toho University, 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan.
| | - Reibin Tai
- Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan.
| | - Toshiyuki Aoki
- Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan.
| | - Sonoo Mizuiri
- Division of Nephrology, Ichiyokai Harada Hospital, Hiroshima 731-5134, Japan.
| | - Toyoko Ogura
- Department of Nutrition, Omori Medical Center, Toho University, Tokyo 143-8541, Japan.
| | - Atsushi Aikawa
- Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan.
| | - Ken Sakai
- Department of Nephrology, Omori Medical Center, School of Medicine, Toho University, Tokyo 143-8541, Japan.
| |
Collapse
|
17
|
Low-protein diet supplemented with ketoacids ameliorates proteinuria in 3/4 nephrectomised rats by directly inhibiting the intrarenal renin-angiotensin system. Br J Nutr 2016; 116:1491-1501. [PMID: 27753426 DOI: 10.1017/s0007114516003536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Low-protein diet plus ketoacids (LPD+KA) has been reported to decrease proteinuria in patients with chronic kidney diseases (CKD). However, the mechanisms have not been clarified. As over-activation of intrarenal renin-angiotensin system (RAS) has been shown to play a key role in the progression of CKD, the current study was performed to investigate the direct effects of LPD+KA on intrarenal RAS, independently of renal haemodynamics. In this study, 3/4 subtotal renal ablated rats were fed 18 % normal-protein diet (Nx-NPD), 6 % low-protein diet (Nx-LPD) or 5 % low-protein diet plus 1 % ketoacids (Nx-LPD+KA) for 12 weeks. Sham-operated rats fed NPD served as controls. The level of proteinuria and expression of renin, angiotensin II (AngII) and its type 1 receptors (AT1R) in the renal cortex were markedly higher in Nx-NPD group than in the sham group. LPD+KA significantly decreased the proteinuria and inhibited intrarenal RAS activation. To exclude renal haemodynamic impact on intrarenal RAS, the serum samples derived from the different groups were added to the culture medium of mesangial cells. It showed that the serum from Nx-NPD directly induced higher expression of AngII, AT1R, fibronectin and transforming growth factor-β1 in the mesangial cells than in the control group. Nx-LPD+KA serum significantly inhibited these abnormalities. Then, proteomics and biochemical detection suggested that the mechanisms underlying these beneficial effects of LPD+KA might be amelioration of the nutritional metabolic disorders and oxidative stress. In conclusion, LPD+KA could directly inhibit the intrarenal RAS activation, independently of renal haemodynamics, thus attenuating the proteinuria in CKD rats.
Collapse
|
18
|
Chan M. Protein-controlled versus restricted protein versus low protein diets in managing patients with non-dialysis chronic kidney disease: a single centre experience in Australia. BMC Nephrol 2016; 17:129. [PMID: 27624699 PMCID: PMC5022230 DOI: 10.1186/s12882-016-0341-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/29/2016] [Indexed: 01/04/2023] Open
Abstract
Nutrition has been an important part of medical management in patients with chronic kidney disease for more than a century. Since the 1970s, due to technological advances in renal replacement therapy (RRT) such as dialysis and transplantation, the importance of nutrition intervention in non-dialysis stages has diminished. In addition, it appears that there is a lack of high-level evidence to support the use of diet therapy, in particular the use of low protein diets to slow down disease progression. However, nutrition abnormalities are known to emerge well before dialysis is required and are associated with poor outcomes post-commencing dialysis. To improve clinical outcomes it is prudent to incorporate practice research and quality audits into routine care, as part of the continuous clinical practice improvement process. This article summarises the experience of and current practices in a metropolitan tertiary teaching hospital in Sydney, Australia.
Collapse
Affiliation(s)
- Maria Chan
- Department of Nutrition and Dietetics, The St. George Hospital, Gray Street, Kogarah, NSW, 2217, Australia. .,Department of Renal Medicine The St. George Hospital, Kogarah, NSW, 2217, Australia. .,Department of Nutrition and Dietetics, School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia. .,St. George Clinical School, School of Medicine, The University of New South Wales, Sydney, NSW, 2217, Australia.
| |
Collapse
|
19
|
Biancone L, Leonardi G, Gai M, Segoloni GP. Secondary Hyperparathyrodism in Adult Predialysis and Dialysis Patients. Updates Surg 2016. [DOI: 10.1007/978-88-470-5758-6_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Effects of Low-Protein Diets Supplemented with Ketoacid on Expression of TGF-β and Its Receptors in Diabetic Rats. BIOMED RESEARCH INTERNATIONAL 2015; 2015:873519. [PMID: 26788514 PMCID: PMC4693005 DOI: 10.1155/2015/873519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/26/2015] [Indexed: 01/04/2023]
Abstract
TGF-β1 has been recognized as a key mediator in DN. This study aimed to observe the effects of low-protein diets supplemented with ketoacid on mRNA and protein expression of TGF-β and TβRI and t TβRII receptors in the renal tissue of diabetic rats. A diabetes model was established in 72 male SD rats. They were then equally randomized to three groups: NPD group, LPD group, and LPD + KA group. Additional 24 male SD rats receiving normal protein diets were used as the control. Eight rats from each group were sacrificed at weeks 4, 8, and 12 after treatment, from which SCr, BUN, serum albumin, and 24 h urinary protein excretion were collected. The expressions of TGF-β1, TβRI, and TβRII in LPD and LPD + KA groups were significantly lower than those in NPD group and lower in LPD + KA group than those in LPD group. Low-protein diets supplemented with ketoacid have been demonstrated to provide a protective effect on the renal function as represented by reduced SCr, BUN, and urinary protein excretion, probably through downregulating the gene expression of TGF-β1 and its receptors in LPD + KA group.
Collapse
|
21
|
Effect of a low-protein diet supplemented with keto-acids on autophagy and inflammation in 5/6 nephrectomized rats. Biosci Rep 2015; 35:BSR20150069. [PMID: 26371333 PMCID: PMC4626871 DOI: 10.1042/bsr20150069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/08/2015] [Indexed: 12/31/2022] Open
Abstract
The present study demonstrated that autophagy/mitophagy was increased and inflammation was aggravated in skeletal muscle in chronic kidney disease (CKD) rats. A low-protein diet (LPD) supplemented with ketoacids (KA) improved the loss in muscle mass and blocked the activation of autophagy/mitophagy and inflammation in those rats. Ketoacids (KA) are known to preserve muscle mass among patients with chronic kidney disease (CKD) on a low-protein diet (LPD). The present study was to compare the effects of KA supplemented diet therapy in autophagy and inflammation in CKD rats' skeletal muscle. Rats with 5/6 nephrectomy were randomly divided into three groups and fed with either 11 g/kg/day protein [normal-protein diet (NPD)], 3 g/kg/day protein (LPD) or 3 g/kg/day protein which including 5% protein plus 1% KA (LPD + KA) for 24 weeks. Sham-operated rats with NPD intake were used as control. LPD could improve body weight, gastrocnemius muscle mass, as well as gastrocnemius muscle cross-sectional area, with the effect being more obvious in the LPD + KA group. The autophagy marker LC3 (microtubule-associated protein 1 light chain 3), p62, Parkin and PTEN induced putative kinase 1 (PINK1) were significantly attenuate in LPD + KA group than LPD group. LPD + KA group had the lower total mtDNA (mitochondiral DNA) and cytosol mtDNA, NACHT-PYD-containing protein 3 (NALP3) inflammasome than LPD group, but its reactive oxygen species (ROS), caspase-1 and apoptosis-associated speck-like protein containing a CARD (ASC) level was higher. Immunoblotting showed IL-1β (interleukin-1-beta) was lower in LPD and LPD + KA group than the NPD group, but IL-18 showed no significant difference among control and CKD group; toll-like receptor signalling-dependent IL-6 was higher in LPD + KA group than LPD group, but tumor necrosis factor-α (TNF-α) was not significantly changed between LPD + KA and LPD group. Systematic changes of the four cytokines were different from that of the tissue. Although LPD + KA could further ameliorate-activated autophagy than LPD, its effect on the activated inflammation state in CKD was not distinctly. Further study is still required to explore the method of ameliorating inflammation to provide new therapeutic approaches for CKD protein energy wasting (PEW).
Collapse
|
22
|
Song Y, Li J, Shin HD, Du G, Liu L, Chen J. One-step biosynthesis of α-ketoisocaproate from L-leucine by an Escherichia coli whole-cell biocatalyst expressing an L-amino acid deaminase from Proteus vulgaris. Sci Rep 2015; 5:12614. [PMID: 26217895 PMCID: PMC4517468 DOI: 10.1038/srep12614] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/03/2015] [Indexed: 11/12/2022] Open
Abstract
This work aimed to develop a whole-cell biotransformation process for the production of α-ketoisocaproate from L-leucine. A recombinant Escherichia coli strain was constructed by expressing an L-amino acid deaminase from Proteus vulgaris. To enhance α-ketoisocaproate production, the reaction conditions were optimized as follows: whole-cell biocatalyst 0.8 g/L, leucine concentration 13.1 g/L, temperature 35 °C, pH 7.5, and reaction time 20 h. Under the above conditions, the α-ketoisocaproate titer reached 12.7 g/L with a leucine conversion rate of 97.8%. In addition, different leucine feeding strategies were examined to increase the α-ketoisocaproate titer. When 13.1 g/L leucine was added at 2-h intervals (from 0 to 22 h, 12 addition times), the α-ketoisocaproate titer reached 69.1 g/L, while the leucine conversion rate decreased to 50.3%. We have developed an effective process for the biotechnological production of α-ketoisocaproate that is more environmentally friendly than the traditional petrochemical synthesis approach.
Collapse
Affiliation(s)
- Yang Song
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Key Laboratory of Industrial Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Synergetic Innovation Center Of Food Safety and Nutrition, Wuxi 214122, China
| | - Jianghua Li
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Key Laboratory of Industrial Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Synergetic Innovation Center Of Food Safety and Nutrition, Wuxi 214122, China
| | - Hyun-dong Shin
- School of Chemical and Biomolecular Engineeirng, Georgia Institute of Technology, Atlanta 30332, USA
| | - Guocheng Du
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Key Laboratory of Industrial Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Synergetic Innovation Center Of Food Safety and Nutrition, Wuxi 214122, China
| | - Long Liu
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Key Laboratory of Industrial Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Synergetic Innovation Center Of Food Safety and Nutrition, Wuxi 214122, China
| | - Jian Chen
- Key Laboratory of Industrial Biotechnology, Ministry of Education, Jiangnan University, Wuxi 214122, China
- Synergetic Innovation Center Of Food Safety and Nutrition, Wuxi 214122, China
| |
Collapse
|
23
|
Mennini FS, Russo S, Marcellusi A, Quintaliani G, Fouque D. Economic effects of treatment of chronic kidney disease with low-protein diet. J Ren Nutr 2015; 24:313-21. [PMID: 25167997 DOI: 10.1053/j.jrn.2014.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 05/03/2014] [Accepted: 05/14/2014] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The most recent literature has shown extensively that a low-protein diet in patients with chronic kidney disease (CKD) delays the natural progression of end-stage renal disease and the necessary treatment of chronic dialysis. The aim of this study was to estimate the cost-effectiveness of a very low-protein diet compared with a moderate low-protein diet. DESIGN Markov model. SETTING The study was conducted from the perspective of the Italian National Health Service. SUBJECTS Patients with CKD stages 4 and 5. Seven hundred and two patients were considered, and half were treated with a very low-protein diet and the other half with a moderate low-protein diet. INTERVENTION The Markov model estimates the costs and the quality-adjusted life years (QALYs) associated with a very low-protein diet versus a moderate low-protein diet for patients with CKD Stages 4 and 5. The transition probability was estimated on data from 7 studies, which determined the efficacy of very low-protein diets in delaying the need to start maintenance dialysis. Utilities and cost were estimated from literature review and projected for the lifespan considered in the model. The annual cost of dialysis per patient was approximately €34,072. The cost of a very low-protein diet was €1,440 per patient per year in the Lazio region (conservative assumptions). Probabilistic and deterministic sensitivity analyses were performed. MAIN OUTCOME MEASURE QALY, cost of treatment, incremental cost-effectiveness ratio. RESULTS The model estimates that a very low-protein diet should be more effective. Dietary treatment improved 0.09 QALYs after 2 years, 0.16 after 3 years, 0.36 after 5 years, and up to 0.93 incremental QALYs after the first 10 years. After 2 years, the model estimated increment cost in favor of the most restrictive dietary treatment of €826, €2,146, €5,203, and €10,375 for 2, 3, 5, and 10 years of follow-up respectively. CONCLUSIONS The results of these simulations indicate that the treatment of CKD patients with a very low-protein diet is cost-effective relative to a moderate low-protein diet in an Italian setting. Further studies should test this model in other countries with different dialysis costs and dietary support.
Collapse
Affiliation(s)
- Francesco S Mennini
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy; Department of Accounting and Finance, Kingston University, London, United Kingdom
| | - Simone Russo
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy; Department of Occupational Medicine, INAIL, Formerly ISPESL, Rome, Italy.
| | - Andrea Marcellusi
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy; Department of Statistics, University of Rome "La Sapienza", Rome, Italy
| | - Giuseppe Quintaliani
- Department of Nephrology Dialysis, Silvestrini Hospital, Perugia, Italy; Department of Cardiology, Silvestrini Hospital, Perugia, Italy
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon Sud, Center for European Nutrition and Safety, Université de Lyon, Lyon, France
| |
Collapse
|
24
|
Lee HW, Osis G, Handlogten ME, Guo H, Verlander JW, Weiner ID. Effect of dietary protein restriction on renal ammonia metabolism. Am J Physiol Renal Physiol 2015; 308:F1463-73. [PMID: 25925252 DOI: 10.1152/ajprenal.00077.2015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/20/2015] [Indexed: 11/22/2022] Open
Abstract
Dietary protein restriction has multiple benefits in kidney disease. Because protein intake is a major determinant of endogenous acid production, it is important that net acid excretion change in parallel during protein restriction. Ammonia is the primary component of net acid excretion, and inappropriate ammonia excretion can lead to negative nitrogen balance. Accordingly, we examined ammonia excretion in response to protein restriction and then we determined the molecular mechanism of the changes observed. Wild-type C57Bl/6 mice fed a 20% protein diet and then changed to 6% protein developed an 85% reduction in ammonia excretion within 2 days, which persisted during a 10-day study. The expression of multiple proteins involved in renal ammonia metabolism was altered, including the ammonia-generating enzymes phosphate-dependent glutaminase (PDG) and phosphoenolpyruvate carboxykinase (PEPCK) and the ammonia-metabolizing enzyme glutamine synthetase. Rhbg, an ammonia transporter, increased in expression in the inner stripe of outer medullary collecting duct intercalated cell (OMCDis-IC). However, collecting duct-specific Rhbg deletion did not alter the response to protein restriction. Rhcg deletion did not alter ammonia excretion in response to dietary protein restriction. These results indicate 1) dietary protein restriction decreases renal ammonia excretion through coordinated regulation of multiple components of ammonia metabolism; 2) increased Rhbg expression in the OMCDis-IC may indicate a biological role in addition to ammonia transport; and 3) Rhcg expression is not necessary to decrease ammonia excretion during dietary protein restriction.
Collapse
Affiliation(s)
- Hyun-Wook Lee
- Division of Nephrology, Hypertension and Transplantation, University of Florida College of Medicine, Gainesville, Florida
| | - Gunars Osis
- Division of Nephrology, Hypertension and Transplantation, University of Florida College of Medicine, Gainesville, Florida
| | - Mary E Handlogten
- Division of Nephrology, Hypertension and Transplantation, University of Florida College of Medicine, Gainesville, Florida
| | - Hui Guo
- Division of Nephrology, Second Hospital of Shanxi Medical University, Yaiyuan, Shanxi, Peoples Republic of China; and
| | - Jill W Verlander
- Division of Nephrology, Hypertension and Transplantation, University of Florida College of Medicine, Gainesville, Florida
| | - I David Weiner
- Division of Nephrology, Hypertension and Transplantation, University of Florida College of Medicine, Gainesville, Florida, Nephrology and Hypertension Section, Medical Service, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| |
Collapse
|
25
|
Huang J, Wang J, Gu L, Bao J, Yin J, Tang Z, Wang L, Yuan W. Effect of a low-protein diet supplemented with ketoacids on skeletal muscle atrophy and autophagy in rats with type 2 diabetic nephropathy. PLoS One 2013; 8:e81464. [PMID: 24303049 PMCID: PMC3841136 DOI: 10.1371/journal.pone.0081464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/14/2013] [Indexed: 02/07/2023] Open
Abstract
A low-protein diet supplemented with ketoacids maintains nutritional status in patients with diabetic nephropathy. The activation of autophagy has been shown in the skeletal muscle of diabetic and uremic rats. This study aimed to determine whether a low-protein diet supplemented with ketoacids improves muscle atrophy and decreases the increased autophagy observed in rats with type 2 diabetic nephropathy. In this study, 24-week-old Goto-Kakizaki male rats were randomly divided into groups that received either a normal protein diet (NPD group), a low-protein diet (LPD group) or a low-protein diet supplemented with ketoacids (LPD+KA group) for 24 weeks. Age- and weight-matched Wistar rats served as control animals and received a normal protein diet (control group). We found that protein restriction attenuated proteinuria and decreased blood urea nitrogen and serum creatinine levels. Compared with the NPD and LPD groups, the LPD+KA group showed a delay in body weight loss, an attenuation in soleus muscle mass loss and a decrease of the mean cross-sectional area of soleus muscle fibers. The mRNA and protein expression of autophagy-related genes, such as Beclin-1, LC3B, Bnip3, p62 and Cathepsin L, were increased in the soleus muscle of GK rats fed with NPD compared to Wistar rats. Importantly, LPD resulted in a slight reduction in the expression of autophagy-related genes; however, these differences were not statistically significant. In addition, LPD+KA abolished the upregulation of autophagy-related gene expression. Furthermore, the activation of autophagy in the NPD and LPD groups was confirmed by the appearance of autophagosomes or autolysosomes using electron microscopy, when compared with the Control and LPD+KA groups. Our results showed that LPD+KA abolished the activation of autophagy in skeletal muscle and decreased muscle loss in rats with type 2 diabetic nephropathy.
Collapse
Affiliation(s)
- Juan Huang
- Department of Nephrology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Jialin Wang
- Department of Nephrology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Lijie Gu
- Department of Nephrology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Jinfang Bao
- Department of Nephrology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Jun Yin
- Department of Nephrology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Zhihuan Tang
- Department of Nephrology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Ling Wang
- Department of Nephrology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Weijie Yuan
- Department of Nephrology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
- * E-mail:
| |
Collapse
|
26
|
Piccoli GB, Ferraresi M, Deagostini MC, Vigotti FN, Consiglio V, Scognamiglio S, Moro I, Clari R, Fassio F, Biolcati M, Porpiglia F. Vegetarian low-protein diets supplemented with keto analogues: a niche for the few or an option for many? Nephrol Dial Transplant 2013; 28:2295-305. [PMID: 23751187 DOI: 10.1093/ndt/gft092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low-protein diets are often mentioned but seldom used to slow chronic kidney disease (CKD) progression. The aim of the study was to investigate the potential for implementation of a simplified low-protein diet supplemented with alpha-keto analogues (LPD-KA) as part of the routine work-up in CKD patients. METHODS In an implementation study (December 2007-November 2011), all patients with CKD Stages IV-V not on dialysis, rapidly progressive Stage III and/or refractory proteinuria, were offered either a simplified LPD-KA, or commercially available low-protein food. LPD-KA consisted of proteins 0.6 g/kg/day, supplementation with Ketosteril 1 pill/10 Kg, 1-3 free-choice meals/week and a simplified schema based on 'allowed' and 'forbidden' foods. 'Success' was defined as at least 6 months on LPD-KA. Progression was defined as reduction in glomerular filtration rate (GFR)[(Chronic Kidney Disease Epidemiology Collaboration) formula CKD-EPI] in patients with at least 6 months of follow-up. RESULTS Of about 2500 patients referred (8% CKD Stages IV-V), 139 started LPD-KA; median age (70 years) and prevalence of comorbidity (79%) were in line with the dialysis population. Start of dialysis was the main reason for discontinuation (40 cases, unplanned in 7); clinical reasons were recorded in 7, personal preference in 14 and improvement and death in 8 each. The low gross mortality (4% per year) and the progression rate (from -8 to 0 mL/min/year at 6 months) are reassuring concerning safety. None of the baseline conditions, including age, educational level, comorbidity or kidney function, discriminated the patients who followed the diet for at least 6 months. CONCLUSIONS Our data suggest a wider offer of LPD-KA to patients with severe and progressive CKD. The promising results in terms of mortality and progression need confirmation with different study designs.
Collapse
Affiliation(s)
- Giorgina B Piccoli
- SS Nephrology, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Turin, Orbassano, Turin, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Noninsulin glucose-lowering agents for the treatment of patients on dialysis. Nat Rev Nephrol 2013; 9:147-53. [DOI: 10.1038/nrneph.2013.12] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
28
|
Fouque D. The phosphorus–proteinuria interaction in chronic kidney disease. Nephrol Dial Transplant 2012; 28:493-5. [DOI: 10.1093/ndt/gfs558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
|
29
|
|