Vol 14, No 2 (2021)
Guidelines / Expert consensus
Published online: 2021-12-31
Low-protein diets and ketoanalogues of amino acids in the treatment of chronic kidney disease — position of the Executive Board of the Polish Society of Nephrology
Renal Disease and Transplantation Forum 2021;14(2):53-57.
Abstract
The NKF DOQI (The National Kidney Foundation Kidney Disease Outcomes Quality Initiative) recommendations from 2020 advice the use in patientswith chronic kidney disease (CKD) 3–5 without diabetes, in a stable metabolic state and under strict medical care, a diet with a protein amount of 0.55–0.6 g/kg/day The use of low-protein with or without ketoanalogues of amino acid reduces the risk of end-stage renal disease. The constantly growing number of patients with advanced chronic kidney disease, the high costs of dialysis therapy and the lack of beneficial effects of early qualification for dialysis on the prognosis of patients cause a renewed interest in the use of low-protein diets with the hope of prolongation conservative treatment. The position of the Polish Society of Nephrology, based on global recommendations and current scientific research results, recommends the use of low-protein diets and amino acid ketanalogues in patients with CKD as part of conservative treatment in a group of patients in good clinical condition, who have no contraindications for this type of proceeding.
Keywords: low-protein dietschronic kidney diseaseconservative treatmentketoanalogues of amino acid
References
- Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020; 76(3 Suppl 1): S1–S107.
- Toigo G, Aparicio M, Attman PO, et al. Expert working group report on nutrition in adult patients with renal insufficiency (Part 2 of 2). Clin Nutr. 2000; 19(4): 281–291.
- Fouque D, Vennegoor M, ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant. 2007; 22 Suppl 2: ii45–ii87.
- Aparicio M, Bellizzi V, Chauveau P, et al. Keto acid therapy in predialysis chronic kidney disease patients: final consensus. J Ren Nutr. 2012; 22(2 Suppl): S22–S24.
- Garneata L, Mircescu G. Effect of low-protein diet supplemented with keto acids on progression of chronic kidney disease. J Ren Nutr. 2013; 23(3): 210–213.
- Aparicio M, Bellizzi V, Chauveau P, et al. Protein-restricted diets plus keto/amino acids--a valid therapeutic approach for chronic kidney disease patients. J Ren Nutr. 2012; 22(2 Suppl): S1–21.
- Aparicio M, Bellizzi V, Chauveau P, et al. Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients? Semin Dial. 2013; 26(6): 714–719.
- Gellert R. Leczenie postępującej niewydolności nerek ketodietą. Wytyczne do programu zapobiegania mocznicy. Grupa Focus, Kraków, Warszawa. ; 2002: 6–67.
- Teschan PE, Beck GJ, Dwyer JT, et al. Effect of a ketoacid-aminoacid-supplemented very low protein diet on the progression of advanced renal disease: a reanalysis of the MDRD feasibility study. Clin Nephrol. 1998; 50(5): 273–283.
- Rutkowski B. Czy leczenie zachowawcze obejmujące dietę niskobiałkową winno być nadal istotnym elementem terapii przewlekłej niewydolności nerek? Nefrol Dial Pol. 2002; 6: 143–145.
- Wang YC, Juan SH, Chou CL, et al. Long-Term Effects of Ketoanalogues on Mortality and Renal Outcomes in Advanced Chronic Kidney Disease Patients Receiving a Low-Protein Diet. Nutrients. 2020; 12(9).
- 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).
- Garneata L, Stancu A, Dragomir D, et al. Ketoanalogue-Supplemented Vegetarian Very Low-Protein Diet and CKD Progression. J Am Soc Nephrol. 2016; 27(7): 2164–2176.
- Fouque D, Wang P, Laville M, et al. Low protein diets delay end-stage renal disease in non diabetic adults with chronic renal failure. Cochrane Database Syst Rev. 2000(2): CD001892.
- Bellizzi V, Calella P, Carrero JJ, et al. Very low-protein diet to postpone renal failure: Pathophysiology and clinical applications in chronic kidney disease. Chronic Dis Transl Med. 2018; 4(1): 45–50.
- Bellizzi V, Calella P, Hernández JN, et al. Safety and effectiveness of low-protein diet supplemented with ketoacids in diabetic patients with chronic kidney disease. BMC Nephrol. 2018; 19(1): 110.
- Fouque D, Chen J, Chen W, et al. Adherence to ketoacids/essential amino acids-supplemented low protein diets and new indications for patients with chronic kidney disease. BMC Nephrol. 2016; 17(1): 63.
- Fouque D, Mitch WE. Low-protein diets in chronic kidney disease: are we finally reaching a consensus? Nephrol Dial Transplant. 2015; 30(1): 6–8.
- Viola B, Pola A, Zubani R, et al. Very low protein diet (VLPD) with ketoanalogue supplements as conservative management of uremia in elderly patients: A single-center experience. Nephrology Dialysis Transplantation. Nephrology Dialysis Transplantation. 2020; 35(Supplement_3).
- Carrero JJ, Stenvinkel P, Cuppari L, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013; 23(2): 77–90.
- Ikizler TA, Cano NJ, Franch H, et al. International Society of Renal Nutrition and Metabolism. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013; 84(6): 1096–1107.
- Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008; 73(4): 391–398.
- Bellizzi V, Calella P, Carrero JJ, et al. Very low-protein diet to postpone renal failure: Pathophysiology and clinical applications in chronic kidney disease. Chronic Dis Transl Med. 2018; 4(1): 45–50.
- Deger S, Ikizler T. Nutrition in Kidney Failure. DeckerMed Nephrology, Dialysis, and Transplantation. 2020.
- Cianciaruso B, Capuano A, D'Amaro E, et al. Dietary compliance to a low protein and phosphate diet in patients with chronic renal failure. Kidney Int Suppl. 1989; 27: S173–S176.
- Małgorzewicz S, Ciechanowski K, Kozłowska L, et al. Zasady żywienia w przewlekłej chorobie nerek — stanowisko Grupy Roboczej Polskiego Towarzystwa Nefrologicznego. Forum Nefrologiczne. 2019; 12: 240–278.
- Piccoli G, Capizzi I, Vigotti FN, et al. Low protein diets and nutritional therapies in CKD: investigating the current global trends. BMC Nephrology. 2017; 18: 102.
