1. Ketoacid Analogues Supplementation in Chronic Kidney Disease and Future Perspectives
- Author
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Laetitia Koppe, Mariana Cassani de Oliveira, Denis Fouque, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), CEMUC, Departamento de Engenharia Mecânica, Universidade de Coimbra, Polo II, 3030-201 Coimbra, Portugal, Universidade de Coimbra [Coimbra], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), CarMeN, laboratoire, and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
intestinal microbiota ,blood-pressure control ,dialyse ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,Physiology ,restriction ,Disease ,Review ,030204 cardiovascular system & hematology ,stress ,0302 clinical medicine ,oxidative ,low protein diet ,renal-disease ,Acidosis ,ketoacid analogues ,intestinal ,Nutrition and Dietetics ,Keto Acids ,3. Good health ,[SDV] Life Sciences [q-bio] ,Alimentation et Nutrition ,maladie rénale ,medicine.symptom ,lcsh:Nutrition. Foods and food supply ,uremic rats ,Normal diet ,Renal function ,lcsh:TX341-641 ,essential amino-acids ,03 medical and health sciences ,low-protein-diet ,microbiote ,Low-protein diet ,medicine ,microbiota ,Diet, Protein-Restricted ,Food and Nutrition ,Humans ,Dietary therapy ,Renal Insufficiency, Chronic ,nephrectomized rats ,Dialysis ,chronic kidney disease ,dialysis ,Nutrition & Dietetics ,business.industry ,medicine.disease ,Dietary Supplements ,régime hypoprotéique ,progression ,business ,nutritional-status ,Food Science ,Kidney disease - Abstract
Diet is a key component of care during chronic kidney disease (CKD). Nutritional interventions, and, specifically, a restricted protein diet has been under debate for decades. In order to reduce the risk of nutritional disorders in very-low protein diets (VLDP), supplementation by nitrogen-free ketoacid analogues (KAs) have been proposed. The aim of this review is to summarize the potential effects of this dietary therapy on renal function, uremic toxins levels, and nutritional and metabolic parameters and propose future directions. The purpose of this paper is also to select all experimental and randomized clinical studies (RCTs) that have compared VLDP + KA to normal diet or/and low protein diet (LPD). We reviewed the SCOPUS, WEB of SCIENCES, CENTRAL, and PUBMED databases from their inception to 1 January, 2019. Following duplicate removal and application of exclusion criteria, 23 RCTs and 12 experimental studies were included. LPD/VLPD + KAs appear nutritionally safe even if how muscle protein metabolism adapts to an LPD/VLPD + KAs is still largely unknown. VLPD + KAs seem to reduce uremic toxins production but the impact on intestinal microbiota remains unexplored. All studies observed a reduction of acidosis, phosphorus, and possibly sodium intake, while still providing adequate calcium intake. The impact of this diet on carbohydrate and bone parameters are only preliminary and need to be confirmed with RCTs. The Modification of Diet in Renal Disease study, the largest RCTs, failed to demonstrate a benefit in the primary outcome of the decline rate for the glomerular filtration rate. However, the design of this study was challenged and data were subsequently reanalyzed. However, when adherent patients were selected, with a rapid rate of progression and a long-term follow up, more recent meta-analysis and RCTs suggest that these diets can reduce the loss of the glomerular filtration rate in addition to the beneficial effects of renin-angiotensin-aldosterone system (RAAS) inhibitors. The current evidence suggests that KAs supplemented LPD diets should be included as part of the clinical recommendations for both the nutritional prevention and metabolic management of CKD. More research is needed to examine the effectiveness of KAs especially on uremic toxins. A reflection about the dose and composition of the KAs supplement, the cost-effective features, and their indication to reduce the frequency of dialysis needs to be completed.
- Published
- 2019