Effectiveness and safety of the use of alpha-keto analogues in the management of advanced chronic kidney disease: clinical practice recommendations
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Keywords

Chronic kidney failure
End-stage renal disease
nutrition science

How to Cite

1.
Ramírez Marmolejo R, Aroca G, González González CA, Pertuz A, Collazos Rozo JM, Galeano JA, Mercado Juri Álvaro. Effectiveness and safety of the use of alpha-keto analogues in the management of advanced chronic kidney disease: clinical practice recommendations: Efectividad y seguridad del uso de alfa-cetoanálogos en el manejo de la enfermedad renal crónica avanzada: recomendaciones para la práctica clínica. Rev. Colomb. Nefrol. [Internet]. 2020 Nov. 5 [cited 2022 Jan. 22];8(1):e465. Available from: https://revistanefrologia.org/index.php/rcn/article/view/465

Abstract

Introduction:
The protein-restricted diet appears to play an important role in the progression of chronic kidney disease and the early onset of uremic symptoms, the supplementation of essential amino acids offers apparent security in achieving aggressive protein restrictions. The objective of this document is to carry out a literature review to inform practical use recommendations on this behavior in advanced Renal Disease (CKD).

Materials and methods:
A quick structured search of the literature is carried out, with the selection of systematic reviews and meta-analyzes, from which the answers to the questions with a PICOT structure designed a priori are extracted. The results were submitted to consensus to generate practical recommendations.

Results:
Six systematic reviews of the literature were included, with a moderate quality evaluation, the extraction of the information reports an apparent benefit of the very low protein diet with supplementation of alpha-keto-analogues on admission to dialysis or kidney transplantation and a consistent reduction of disease progression. Better clinical trials that integrate outcomes such as quality of life are required.

Conclusions:
With low quality of evidence, the very low protein diet, supplemented with alpha-keto analogues, in the properly selected patient, reduces the deterioration of the glomerular filtration rate, seems to reduce admission to dialysis. Regular strict monitoring is recommended, with monitoring of anthropometric measures and malnutrition risk profile.

https://doi.org/10.22265/acnef.8.1.465
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References

Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2014;63(5):713-35. https://doi.org/10.1053/j.ajkd.2014.01.416

Levin A, Stevens PE. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney international. 2014;85(1):49-61. https://doi.org/10.1038/ki.2013.444

Moist LM, Al-Jaishi AA. Preparation of the Dialysis Access in Stages 4 and 5 CKD. Advances in chronic kidney disease. 2016;23(4):270-5. https://doi.org/10.1053/j.ackd.2016.04.001

Muscaritoli M, Krznaric Z, Singer P, Barazzoni R, Cederholm T, Golay A, et al. Effectiveness and efficacy of nutritional therapy: A systematic review following Cochrane methodology. Clinical nutrition (Edinburgh, Scotland). 2017;36(4):939-57. https://doi.org/10.1016/j.clnu.2016.06.022

Kalantar-Zadeh K, Fouque D. Nutritional Management of Chronic Kidney Disease. New England Journal of Medicine. 2017;377(18):1765-76. https://doi.org/10.1056/NEJMra1700312

Mitch W, Walser M. Nitrogen balance of uremic patients receiving branched-chain ketoacids and the hydroxy-analogue of methionine as substitutes for the respective amino acids. Clinical nephrology. 1977;8(2):341-4.

Walser M, Coulter AW, Dighe S, Crantz FR. The effect of keto-analogues of essential amino acids in severe chronic uremia. The Journal of clinical investigation. 1973;52(3):678-90. https://doi.org/10.1172/JCI107229

Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Clinical research ed). https://doi.org/10.1136/bmj.j4008

Rhee CM, Ahmadi SF, Kovesdy CP, Kalantar-Zadeh K. Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials. J Cachexia Sarcopenia Muscle. 2018;9(2):235-45. https://doi.org/10.1002/jcsm.12264

Jiang Z, Zhang X, Yang L, Li Z, Qin W. Effect of restricted protein diet supplemented with keto analogues in chronic kidney disease: a systematic review and meta-analysis. International Urology and Nephrology. 2015;48(3):409-18. https://doi.org/10.1007/s11255-015-1170-2

Chewcharat A, Takkavatakarn K, Wongrattanagorn S, Panrong K, Kittiskulnam P, Eiam-Ong S, et al. The Effects of Restricted Protein Diet Supplemented With Ketoanalogue on Renal Function, Blood Pressure, Nutritional Status, and Chronic Kidney Disease-Mineral and Bone Disorder in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis. J Ren Nutr. 2019. https://doi.org/10.1053/j.jrn.2019.07.005

Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev. 2018;10:CD001892. https://doi.org/10.1002/14651858.CD001892.pub4

Yan B, Su X, Xu B, Qiao X, Wang L. Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis. PLoS One. https://doi.org/10.1371/journal.pone.0206134

Li A, Lee HY, Lin YC. The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis. Nutrients. 2019;11(5). https://doi.org/10.3390/nu11050957

Garneata L, Stancu A, Dragomir D, Stefan G, Mircescu G. Ketoanalogue-Supplemented Vegetarian Very Low-Protein Diet and CKD Progression. Journal of the American Society of Nephrology : JASN. 2016;27(7):2164-76. https://doi.org/10.1681/ASN.2015040369

Goraya N, Wesson DE. Dietary Protein as Kidney Protection: Quality or Quantity? Journal of the American Society of Nephrology. 2016;27(7):1877-9. https://doi.org/10.1681/ASN.2015111286

Cianciaruso B, Pota A, Pisani A, Torraca S, Annecchini R, Lombardi P, et al. Metabolic effects of two low protein diets in chronic kidney disease stage 4-5--a randomized controlled trial. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2008;23(2):636-44. https://doi.org/10.1093/ndt/gfm576

Zhang J, Xie H, Fang M, Wang K, Chen J, Sun W, et al. Keto-supplemented Low Protein Diet: A Valid Therapeutic Approach for Patients with Steroid-resistant Proteinuria during Early-stage Chronic Kidney Disease. The journal of nutrition, health & aging. 2016;20(4):420-7. https://doi.org/10.1007/s12603-015-0612-y

Mircescu G, Garneata L, Stancu SH, Capusa C. Effects of a supplemented hypoproteic diet in chronic kidney disease. J Ren Nutr. 2007;17(3):179-88. https://doi.org/10.1053/j.jrn.2006.12.012

Bellizzi V, Di Iorio BR, De Nicola L, Minutolo R, Zamboli P, Trucillo P, et al. Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney international. 2007;71(3):245-51. https://doi.org/10.1038/sj.ki.5001955

Maroni BJ, Steinman TI, Mitch WE. A method for estimating nitrogen intake of patients with chronic renal failure. Kidney international. 1985;27(1):58-65. https://doi.org/10.1038/ki.1985.10

Pedrini M, Levey A, Lau J, et al. The Effect of the Dietary Protein Restriction on the Progression of Diabetic and no Diabetic Renal Diseases: A Meta-Analysis. Ann Intern Med 1996; 124 (17): 627-632 https://doi.org/10.7326/0003-4819-124-7-199604010-00002

Fouque_D, Wang_PH, Laville_M, Boissel_JP. Low protein diets for chronic renal failure in non-diabetic adults. Cochrane Database of Systematic Reviews 2000, Issue 4. https://doi.org/10.1002/14651858.CD001892

Fouque_D, Laville_M, Boissel_J-P. Low protein diets for chronic kidney disease in non-diabetic adults. Cochrane Database of Systematic Reviews 2006, Issue 1. https://doi.org/10.1002/14651858.CD001892.pub2

Fouque_D, Laville_M. Low protein diets for chronic kidney disease in non-diabetic adults. Cochrane Database of Systematic Reviews 2009, Issue 2. https://doi.org/10.1002/14651858.CD001892.pub3

Moe Sh, Zidehsarai M, Chambers M, et al. Vegetarian Compared with Meat Dietary Protein Source and Phosphorus Homeostasis in Chronic Kidney Disease. Clin J Am Soc Nephrol 6: 257-264, 2011 https://doi.org/10.2215/CJN.05040610

Malvy D. Maingourd C, Pengloan J, et al. Effects of Severe Protein Restriction with Ketoanalogues in Advanced Renal Failure. J Am Coll Nutr 1999; 18(5): 481-486 https://doi.org/10.1080/07315724.1999.10718887

Klahr S, Levey A, Beck G, et al. The Effects of Dietary Protein Restriccion and Blood Pressure Control on the Progresion of Chronic Renal Disease. N Engl J Med. 194, March 31; 330 (13): 877-884 https://doi.org/10.1056/NEJM199403313301301

Kovesdy C, Kopel J, Kalantar Zadeh K. Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with. Am J Clin Nutr 2013;97:1163-77. https://doi.org/10.3945/ajcn.112.036418

Chauveu P, Venderly B, Haggan W, et al. Body Composition of Patients on a Very Low-Protein Diet: A Two-Year Survey With DEXA. Journal of Renal Nutrition, Vol 13, No 4 (October), 2003: pp 282-287 https://doi.org/10.1016/S1051-2276(03)00117-1

MilanovaL, Fomin V, Moiseev S, Effect of essential amino acid ?etoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and ?lotho) in 3b-4 stages chronic ?idney disease patients: a randomized pilot study. Clinical and Experimental Nephrology (2018) 22:1351-1359 https://doi.org/10.1007/s10157-018-1591-1

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