The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis

Overview

Journal Nutrients

Date 2019 May 1

PMID 31035482

Citations 24

Authors

Albert Li

Hsiang-Yen Lee

Yen-Chung Lin

Affiliations

Soon will be listed here.

Abstract

The effects of ketoanalogues (KA) on chronic kidney disease (CKD) deterioration have not yet been fully confirmed. To strengthen the evidence of the role of KA in CKD, PubMed and Embase were searched for studies published through February 2019. Effect sizes from ten randomized control trials (RCTs) and two non-RCTs comprising a total of 951 patients were pooled and analyzed. A restricted protein diet supplemented with ketoanalogues (RPKA) was found to significantly delay the progression of CKD ( = 0.008), particularly in patients with an estimated glomerular filtration rate (eGFR) > 18 mL/min/1.73 m ( < 0.0001). No significant change in eGFR was found when comparing a very-low-protein diet and a low-protein diet ( = 0.10). In addition, compared with the placebo, RPKA did not cause malnutrition (albumin: = 0.56; cholesterol: = 0.50). Moreover, RPKA significantly decreased phosphorous levels ( = 0.001), increased calcium levels ( = 0.04), and decreased parathyroid hormone (PTH) levels ( = 0.05) in patients with eGFR < 18 mL/min/1.73 m. In conclusion, RPKA could slow down the progression of CKD in patients with eGFR > 18 mL/min/1.73 m without causing malnutrition and reverse CKD-MBD in patients with eGFR < 18 mL/min/1.73 m.

Citing Articles

How to Give Dietary Advice to Patients with Kidney Disease?.

Sinha A, Prasad N Indian J Nephrol. 2025; 35(2):178-186.

PMID: 40060062 PMC: 11883307. DOI: 10.25259/IJN_139_2024.

Keto Analogues in Patients with Chronic Kidney Disease with or Without Kidney Transplantation.

Kleinova P, Blichova T, Granak K, Kollar A, Vnucak M, Dedinska I Nutrients. 2024; 16(23).

PMID: 39683395 PMC: 11643585. DOI: 10.3390/nu16234001.

Ketoanalogue use is associated with a lower risk of worsening frailty among patients with diabetic kidney disease of advanced stage: A retrospective cohort study.

Wang J, Lee S, Chao C, Huang J, Chien K Heliyon. 2024; 10(22):e40392.

PMID: 39641054 PMC: 11617760. DOI: 10.1016/j.heliyon.2024.e40392.

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

Chen C, Tsai P, Tsai W, Ko M, Hsu L, Chien K J Nephrol. 2024; 37(8):2113-2125.

PMID: 39340710 DOI: 10.1007/s40620-024-02065-9.

Appropriateness of Ketoanalogues of Amino Acids, Calcium Citrate, and Inulin Supplementation for CKD Management: A RAND/UCLA Consensus.

Saavedra-Fuentes N, Carmona-Montesinos E, Castaneda-Hernandez G, Campos I, Castillo-Salinas J, Castillo-Tapia J Nutrients. 2024; 16(17).

PMID: 39275246 PMC: 11397001. DOI: 10.3390/nu16172930.

References

Malvy D, Maingourd C, Pengloan J, BAGROS P, Nivet H . Effects of severe protein restriction with ketoanalogues in advanced renal failure. J Am Coll Nutr. 1999; 18(5):481-6. DOI: 10.1080/07315724.1999.10718887. View

Bernhard J, Beaufrere B, Laville M, Fouque D . Adaptive response to a low-protein diet in predialysis chronic renal failure patients. J Am Soc Nephrol. 2001; 12(6):1249-1254. DOI: 10.1681/ASN.V1261249. View

Levin A . Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial. 2003; 16(2):101-5. DOI: 10.1046/j.1525-139x.2003.16025.x. View

Feneberg R, Schaefer F, Veldhuis J . Neuroendocrine adaptations in renal disease. Pediatr Nephrol. 2003; 18(6):492-7. DOI: 10.1007/s00467-003-1160-y. View

Stevens L, Djurdjev O, Cardew S, Cameron E, Levin A . Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol. 2004; 15(3):770-9. DOI: 10.1097/01.asn.0000113243.24155.2f. View

Prakash S, Pande D, Sharma S, Sharma D, Bal C, Kulkarni H . Randomized, double-blind, placebo-controlled trial to evaluate efficacy of ketodiet in predialytic chronic renal failure. J Ren Nutr. 2004; 14(2):89-96. DOI: 10.1053/j.jrn.2004.01.008. View

Block G, Klassen P, Lazarus J, Ofsthun N, Lowrie E, Chertow G . Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8):2208-18. DOI: 10.1097/01.ASN.0000133041.27682.A2. View

Feiten S, Draibe S, Watanabe R, Duenhas M, Baxmann A, Nerbass F . Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients. Eur J Clin Nutr. 2004; 59(1):129-36. DOI: 10.1038/sj.ejcn.1602050. View

Young E, Albert J, Satayathum S, Goodkin D, Pisoni R, Akiba T . Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2005; 67(3):1179-87. DOI: 10.1111/j.1523-1755.2005.00185.x. View

10.

Pupim L, Flakoll P, Majchrzak K, Guy D, Stenvinkel P, Ikizler T . Increased muscle protein breakdown in chronic hemodialysis patients with type 2 diabetes mellitus. Kidney Int. 2005; 68(4):1857-65. DOI: 10.1111/j.1523-1755.2005.00605.x. View

11.

McClellan W, Jurkovitz C, Abramson J . The epidemiology and control of anaemia among pre-ESRD patients with chronic kidney disease. Eur J Clin Invest. 2005; 35 Suppl 3:58-65. DOI: 10.1111/j.1365-2362.2005.01532.x. View

12.

Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M . Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol. 2006; 17(7):2034-47. DOI: 10.1681/ASN.2005101085. View

13.

Bellizzi V, Di Iorio B, De Nicola L, Minutolo R, Zamboli P, Trucillo P . Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney Int. 2006; 71(3):245-51. DOI: 10.1038/sj.ki.5001955. View

14.

Moe S, Drueke T, Lameire N, Eknoyan G . Chronic kidney disease-mineral-bone disorder: a new paradigm. Adv Chronic Kidney Dis. 2007; 14(1):3-12. DOI: 10.1053/j.ackd.2006.10.005. View

15.

Mircescu G, Garneata L, Stancu S, Capusa C . Effects of a supplemented hypoproteic diet in chronic kidney disease. J Ren Nutr. 2007; 17(3):179-88. DOI: 10.1053/j.jrn.2006.12.012. View

16.

Mitch W . Dietary protein restriction in chronic renal failure: nutritional efficacy, compliance, and progression of renal insufficiency. J Am Soc Nephrol. 1991; 2(4):823-31. DOI: 10.1681/ASN.V24823. View

17.

Fouque D, Aparicio M . Eleven reasons to control the protein intake of patients with chronic kidney disease. Nat Clin Pract Nephrol. 2007; 3(7):383-92. DOI: 10.1038/ncpneph0524. View

18.

Shrier I, Boivin J, Steele R, Platt R, Furlan A, Kakuma R . Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. Am J Epidemiol. 2007; 166(10):1203-9. DOI: 10.1093/aje/kwm189. View

19.

Teplan V, Schuck O, Racek J, Mareckova O, Stollova M, Hanzal V . Reduction of plasma asymmetric dimethylarginine in obese patients with chronic kidney disease after three years of a low-protein diet supplemented with keto-amino acids: a randomized controlled trial. Wien Klin Wochenschr. 2008; 120(15-16):478-85. DOI: 10.1007/s00508-008-0987-4. View

20.

Menon V, Kopple J, Wang X, Beck G, Collins A, Kusek J . Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. Am J Kidney Dis. 2008; 53(2):208-17. DOI: 10.1053/j.ajkd.2008.08.009. View