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Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study.
Nutrients. 2018 Aug 08; 10(8)N

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.

Authors+Show Affiliations

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan. b9102087@yahoo.com.tw.Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan. 8902086@cgmh.org.tw.Department of Cardiology, Chang Gung Memorial Hospital, Chiayi branch, Chiayi 61363, Taiwan. mingshyan@cgmh.org.tw.Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan. shwchang@mail.cgu.edu.tw. Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33341, Taiwan. shwchang@mail.cgu.edu.tw.Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan. franwis1023@gmail.com.Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan. colinhua0123@gmail.com.Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan. Chaoyuclaire@gmail.com.Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan. hsianghao@gmail.com.Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan. dryctian@yahoo.com.Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan. franwisandsun@gmail.com.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

30096785

Citation

Yen, Chieh-Li, et al. "Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? a Nationwide Cohort Study." Nutrients, vol. 10, no. 8, 2018.
Yen CL, Tu KH, Lin MS, et al. Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study. Nutrients. 2018;10(8).
Yen, C. L., Tu, K. H., Lin, M. S., Chang, S. W., Fan, P. C., Hsiao, C. C., Chen, C. Y., Hsu, H. H., Tian, Y. C., & Chang, C. H. (2018). Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study. Nutrients, 10(8). https://doi.org/10.3390/nu10081035
Yen CL, et al. Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? a Nationwide Cohort Study. Nutrients. 2018 Aug 8;10(8) PubMed PMID: 30096785.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study. AU - Yen,Chieh-Li, AU - Tu,Kun-Hua, AU - Lin,Ming-Shyan, AU - Chang,Su-Wei, AU - Fan,Pei-Chun, AU - Hsiao,Ching-Chung, AU - Chen,Chao-Yu, AU - Hsu,Hsiang-Hao, AU - Tian,Ya-Chun, AU - Chang,Chih-Hsiang, Y1 - 2018/08/08/ PY - 2018/07/20/received PY - 2018/08/03/revised PY - 2018/08/06/accepted PY - 2018/8/12/entrez PY - 2018/8/12/pubmed PY - 2018/11/27/medline KW - adverse events KW - chronic kidney disease KW - ketoacids KW - low-protein diet KW - nutrition KW - survival JF - Nutrients JO - Nutrients VL - 10 IS - 8 N2 - 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. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/30096785/Does_a_Supplemental_Low_Protein_Diet_Decrease_Mortality_and_Adverse_Events_After_Commencing_Dialysis_A_Nationwide_Cohort_Study_ DB - PRIME DP - Unbound Medicine ER -