Ketoacid Analogues Supplementation in Chronic Kidney Disease and Future Perspectives

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dc.contributor.authorKoppe, Laetitia
dc.contributor.authorCassani de Oliveira, Mariana [UNESP]
dc.contributor.authorFouque, Denis
dc.contributor.institutionCentre Hospitalier Lyon-Sud
dc.contributor.institutionINRA
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2019-10-06T16:46:05Z
dc.date.available2019-10-06T16:46:05Z
dc.date.issued2019-09-03
dc.description.abstractDiet 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.en
dc.description.affiliationDepartment of Nephrology Hospices Civils de Lyon Centre Hospitalier Lyon-Sud
dc.description.affiliationUniv. Lyon CarMeN Laboratory INSA-Lyon Inserm U1060 INRA, Université Claude Bernard Lyon 1
dc.description.affiliationDepartment of Medical Clinic Botucatu Medical School Universidade Estadual Paulista-UNESP
dc.description.affiliationUnespDepartment of Medical Clinic Botucatu Medical School Universidade Estadual Paulista-UNESP
dc.identifierhttp://dx.doi.org/10.3390/nu11092071
dc.identifier.citationNutrients, v. 11, n. 9, 2019.
dc.identifier.doi10.3390/nu11092071
dc.identifier.issn2072-6643
dc.identifier.scopus2-s2.0-85071767874
dc.identifier.urihttp://hdl.handle.net/11449/189606
dc.language.isoeng
dc.relation.ispartofNutrients
dc.rights.accessRightsAcesso aberto
dc.sourceScopus
dc.subjectchronic kidney disease
dc.subjectdialysis
dc.subjectintestinal microbiota
dc.subjectketoacid analogues
dc.subjectlow protein diet
dc.titleKetoacid Analogues Supplementation in Chronic Kidney Disease and Future Perspectivesen
dc.typeResenha
unesp.author.orcid0000-0002-9707-7199 0000-0002-9707-7199[3]

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