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Nutrients. 2019 Apr 26;11(5). pii: E957. doi: 10.3390/nu11050957.

The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis.

Li A1,2, Lee HY3, Lin YC4,5,6.

Author information

1
Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 111, Taiwan. albert0325162@gmail.com.
2
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 111, Taiwan. albert0325162@gmail.com.
3
Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 111, Taiwan. plumlikesalt@gmail.com.
4
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 111, Taiwan. yclin0229@tmu.edu.tw.
5
Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 111, Taiwan. yclin0229@tmu.edu.tw.
6
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 111, Taiwan. yclin0229@tmu.edu.tw.

Abstract

The effects of ketoanalogues (KA) on chronic kidney disease (CKD) deterioration have not yet been fully confirmed. To strengthen the evidence of the role of KA in CKD, PubMed and Embase were searched for studies published through February 2019. Effect sizes from ten randomized control trials (RCTs) and two non-RCTs comprising a total of 951 patients were pooled and analyzed. A restricted protein diet supplemented with ketoanalogues (RPKA) was found to significantly delay the progression of CKD (p = 0.008), particularly in patients with an estimated glomerular filtration rate (eGFR) > 18 mL/min/1.73 m2 (p < 0.0001). No significant change in eGFR was found when comparing a very-low-protein diet and a low-protein diet (p = 0.10). In addition, compared with the placebo, RPKA did not cause malnutrition (albumin: p = 0.56; cholesterol: p = 0.50). Moreover, RPKA significantly decreased phosphorous levels (p = 0.001), increased calcium levels (p = 0.04), and decreased parathyroid hormone (PTH) levels (p = 0.05) in patients with eGFR < 18 mL/min/1.73 m2. In conclusion, RPKA could slow down the progression of CKD in patients with eGFR > 18 mL/min/1.73 m2 without causing malnutrition and reverse CKD-MBD in patients with eGFR < 18 mL/min/1.73 m2.

KEYWORDS:

chronic kidney disease; estimated glomerular filtration rate; ketoanalogue; restricted protein diet

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