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Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis?
Nutrients. 2020 Oct 31; 12(11)N

Abstract

BACKGROUND

Previous studies have demonstrated that dietary therapy can delay the initiation of dialysis, but little research has investigated whether patients with very poor renal function would benefit from a dietary therapy.

METHODS

This study was performed by using the Chang Gung Research Database (CGRD), which is based on the largest medical system in Taiwan. Patients with estimated glomerular filtration rates (eGFR) < 15 mL/min/1.73 m2 between 2001 and 2015 with more than 3 months of low-protein diet supplemented with ketoanalogues (sLPD) were extracted (Ketosteril group). We then assigned five patients without any sLPD to match one patient of the Ketosteril group (comparison group). Both groups were followed up for 1 year for the initiation of dialysis and rates of major adverse cardiac and cerebrovascular events (MACCEs).

RESULTS

The Ketosteril group (n = 547), compared with the comparison group (n = 2735), exhibited a lower incidence of new-onset dialysis (40.2% vs. 44.4%, subdistribution hazard ratio (SHR): 0.80, 95% confidence interval (CI): 0.70-0.91) and MACCEs (3.7% vs. 5.9%, HR: 0.61, 95% CI: 0.38-0.97). The beneficial effect of an sLPD did not differ in patients with a baseline eGFR < 5 mL/min/1.73 m2.

CONCLUSION

Even among patients with extremely low eGFR, sLPD treatment can safely delay the need for dialysis.

Links

Authors+Show Affiliations

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan. College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan.

MeSH

AgedAmino Acids, EssentialDiet, Protein-RestrictedDietary SupplementsDisease ProgressionFemaleGlomerular Filtration RateHumansMaleMiddle AgedProportional Hazards ModelsRenal DialysisRenal Insufficiency, ChronicRetrospective StudiesTaiwanTreatment Outcome

Pub Type(s)

Evaluation Study

Journal Article

Language

eng

PubMed ID

33142717

Citation

Yen, Chieh-Li, et al. "Advanced Chronic Kidney Disease With Low and Very Low GFR: Can a Low-Protein Diet Supplemented With Ketoanalogues Delay Dialysis?" Nutrients, vol. 12, no. 11, 2020.

Yen CL, Fan PC, Lee CC, et al. Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis? Nutrients. 2020;12(11).

Yen, C. L., Fan, P. C., Lee, C. C., Kuo, G., Tu, K. H., Chen, J. J., Lee, T. H., Hsu, H. H., Tian, Y. C., & Chang, C. H. (2020). Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis? Nutrients, 12(11). https://doi.org/10.3390/nu12113358

Yen CL, et al. Advanced Chronic Kidney Disease With Low and Very Low GFR: Can a Low-Protein Diet Supplemented With Ketoanalogues Delay Dialysis. Nutrients. 2020 Oct 31;12(11) PubMed PMID: 33142717.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis? AU - Yen,Chieh-Li, AU - Fan,Pei-Chun, AU - Lee,Cheng-Chia, AU - Kuo,George, AU - Tu,Kun-Hua, AU - Chen,Jia-Jin, AU - Lee,Tao-Han, AU - Hsu,Hsiang-Hao, AU - Tian,Ya-Chun, AU - Chang,Chih-Hsiang, Y1 - 2020/10/31/ PY - 2020/10/07/received PY - 2020/10/25/revised PY - 2020/10/29/accepted PY - 2020/11/4/entrez PY - 2020/11/5/pubmed PY - 2021/4/20/medline KW - Ketosteril KW - adverse events KW - chronic kidney disease KW - dialysis KW - low-protein diet JF - Nutrients JO - Nutrients VL - 12 IS - 11 N2 - BACKGROUND: Previous studies have demonstrated that dietary therapy can delay the initiation of dialysis, but little research has investigated whether patients with very poor renal function would benefit from a dietary therapy. METHODS: This study was performed by using the Chang Gung Research Database (CGRD), which is based on the largest medical system in Taiwan. Patients with estimated glomerular filtration rates (eGFR) < 15 mL/min/1.73 m2 between 2001 and 2015 with more than 3 months of low-protein diet supplemented with ketoanalogues (sLPD) were extracted (Ketosteril group). We then assigned five patients without any sLPD to match one patient of the Ketosteril group (comparison group). Both groups were followed up for 1 year for the initiation of dialysis and rates of major adverse cardiac and cerebrovascular events (MACCEs). RESULTS: The Ketosteril group (n = 547), compared with the comparison group (n = 2735), exhibited a lower incidence of new-onset dialysis (40.2% vs. 44.4%, subdistribution hazard ratio (SHR): 0.80, 95% confidence interval (CI): 0.70-0.91) and MACCEs (3.7% vs. 5.9%, HR: 0.61, 95% CI: 0.38-0.97). The beneficial effect of an sLPD did not differ in patients with a baseline eGFR < 5 mL/min/1.73 m2. CONCLUSION: Even among patients with extremely low eGFR, sLPD treatment can safely delay the need for dialysis. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/33142717/Advanced_Chronic_Kidney_Disease_with_Low_and_Very_Low_GFR:_Can_a_Low_Protein_Diet_Supplemented_with_Ketoanalogues_Delay_Dialysis DB - PRIME DP - Unbound Medicine ER -