Tags

Type your tag names separated by a space and hit enter

Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study.
Nephrol Dial Transplant. 2015 Jan; 30(1):71-7.ND

Abstract

BACKGROUND

Very low-protein intake during chronic kidney disease (CKD) improves metabolic disorders and may delay dialysis start without compromising nutritional status, but concerns have been raised on a possible negative effect on survival during dialysis. This study aimed at evaluating whether a very low-protein diet during CKD is associated with a greater risk of death while on dialysis treatment.

METHODS

This is an historical, cohort, controlled study, enrolling patients at dialysis start previously treated in a tertiary nephrology clinic with a very low-protein diet supplemented with amino acids and ketoacids (s-VLPD group, n = 184) or without s-VLPD [tertiary nephrology care (TNC) group, n = 334] and unselected patients [control (CON) group, n = 9.092]. The major outcome was survival rate during end-stage renal disease associated to s-VLPD treatment during CKD. The propensity score methods and Cox regression model were used to match groups at the start of dialysis to perform survival analysis and estimate adjusted hazard ratio (HR).

RESULTS

In s-VLPD, TNC and CON groups, average age was 67.5, 66.0 and 66.3 years, respectively (P = 0.521) and male prevalence was 55, 55 and 62%, respectively (P = 0.004). Diabetes prevalence differed in the three groups (P < 0.001), being 18, 17 and 31% in s-VLPD, CON and TNC, respectively. A different prevalence of cardiovascular (CV) disease was found (P < 0.001), being similar in TNC and CON (31 and 25%) and higher in s-VLPD (41%). Median follow-up during renal replacement therapy (RRT) was 36, 32 and 36 months in the three groups. Adjusted HR estimated on matched propensity patients was 0.59 (0.45-0.78) for s-VLPD versus CON. Subgroup analysis showed a lower mortality risk in s-VLPD versus matched-CON in younger patients (<70 years) and those without CV disease. No significant difference in HRs was found between s-VLPD and TNC.

CONCLUSION

s-VLPD during CKD does not increase mortality in the subsequent RRT period.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Bellizzi V
Division of Nephrology, Dialysis and Renal Transplantation, 'San Giovanni di Dio e Ruggi d'Aragona' University Hospital of Salerno, Salerno, Italy.
Chiodini P
Medical Statistics Unit, Second University of Napoli, Napoli, Italy.
Cupisti A
Nephrology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Viola BF
Nephrology Unit, A.O. Spedali Civili, University of Brescia, Brescia, Italy.
Pezzotta M
Nephrology Unit, A.O. Spedali Civili, University of Brescia, Brescia, Italy.
De Nicola L
Nephrology Unit, Med School, Second University of Naples, Napoli, Italy.
Minutolo R
Nephrology Unit, Med School, Second University of Naples, Napoli, Italy.
Barsotti G
Nephrology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Piccoli GB
Nephrology Unit, San Luigi University Hospital, Orbassano, Turin, Italy.
Di Iorio B
Nephrology Unit, Landolfi' Hospital, Solofra, Avellino, Italy.

MeSH

AgedAmino AcidsCardiovascular DiseasesDiet, Protein-RestrictedFemaleHumansItalyKeto AcidsMaleNutritional StatusPrevalencePrognosisProspective StudiesRenal DialysisRenal Insufficiency, ChronicRenal Replacement TherapyRisk FactorsSurvival Rate

Pub Type(s)

Controlled Clinical Trial
Journal Article
Multicenter Study

Language

eng

PubMed ID

25082793

Clinical Trial Links

Renal Effects of Meditarranean Diet and Low-protein Diet With Ketoacids on Physiological Intestinal Mibrobiota in CKD

Citation

Bellizzi, Vincenzo, et al. "Very Low-protein Diet Plus Ketoacids in Chronic Kidney Disease and Risk of Death During End-stage Renal Disease: a Historical Cohort Controlled Study." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 30, no. 1, 2015, pp. 71-7.
Bellizzi V, Chiodini P, Cupisti A, et al. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrol Dial Transplant. 2015;30(1):71-7.
Bellizzi, V., Chiodini, P., Cupisti, A., Viola, B. F., Pezzotta, M., De Nicola, L., Minutolo, R., Barsotti, G., Piccoli, G. B., & Di Iorio, B. (2015). Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 30(1), 71-7. https://doi.org/10.1093/ndt/gfu251
Bellizzi V, et al. Very Low-protein Diet Plus Ketoacids in Chronic Kidney Disease and Risk of Death During End-stage Renal Disease: a Historical Cohort Controlled Study. Nephrol Dial Transplant. 2015;30(1):71-7. PubMed PMID: 25082793.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. AU - Bellizzi,Vincenzo, AU - Chiodini,Paolo, AU - Cupisti,Adamasco, AU - Viola,Battista Fabio, AU - Pezzotta,Mauro, AU - De Nicola,Luca, AU - Minutolo,Roberto, AU - Barsotti,Giuliano, AU - Piccoli,Giorgina Barbara, AU - Di Iorio,Biagio, Y1 - 2014/07/30/ PY - 2014/8/2/entrez PY - 2014/8/2/pubmed PY - 2015/6/24/medline KW - CKD KW - CV risk KW - ketoacids KW - survival KW - very low-protein diet SP - 71 EP - 7 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 30 IS - 1 N2 - BACKGROUND: Very low-protein intake during chronic kidney disease (CKD) improves metabolic disorders and may delay dialysis start without compromising nutritional status, but concerns have been raised on a possible negative effect on survival during dialysis. This study aimed at evaluating whether a very low-protein diet during CKD is associated with a greater risk of death while on dialysis treatment. METHODS: This is an historical, cohort, controlled study, enrolling patients at dialysis start previously treated in a tertiary nephrology clinic with a very low-protein diet supplemented with amino acids and ketoacids (s-VLPD group, n = 184) or without s-VLPD [tertiary nephrology care (TNC) group, n = 334] and unselected patients [control (CON) group, n = 9.092]. The major outcome was survival rate during end-stage renal disease associated to s-VLPD treatment during CKD. The propensity score methods and Cox regression model were used to match groups at the start of dialysis to perform survival analysis and estimate adjusted hazard ratio (HR). RESULTS: In s-VLPD, TNC and CON groups, average age was 67.5, 66.0 and 66.3 years, respectively (P = 0.521) and male prevalence was 55, 55 and 62%, respectively (P = 0.004). Diabetes prevalence differed in the three groups (P < 0.001), being 18, 17 and 31% in s-VLPD, CON and TNC, respectively. A different prevalence of cardiovascular (CV) disease was found (P < 0.001), being similar in TNC and CON (31 and 25%) and higher in s-VLPD (41%). Median follow-up during renal replacement therapy (RRT) was 36, 32 and 36 months in the three groups. Adjusted HR estimated on matched propensity patients was 0.59 (0.45-0.78) for s-VLPD versus CON. Subgroup analysis showed a lower mortality risk in s-VLPD versus matched-CON in younger patients (<70 years) and those without CV disease. No significant difference in HRs was found between s-VLPD and TNC. CONCLUSION: s-VLPD during CKD does not increase mortality in the subsequent RRT period. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/25082793/Very_low_protein_diet_plus_ketoacids_in_chronic_kidney_disease_and_risk_of_death_during_end_stage_renal_disease:_a_historical_cohort_controlled_study_ DB - PRIME DP - Unbound Medicine ER -