scholarly journals Effects of Low Protein Diet on Modulating Gut Microbiota in Patients with Chronic Kidney Disease: A Systematic Review and Meta-analysis of International Studies

2021 ◽  
Vol 18 (16) ◽  
pp. 3839-3850
Author(s):  
Cheng-Kai Hsu ◽  
Shih-Chi Su ◽  
Lun-Ching Chang ◽  
Shih-Chieh Shao ◽  
Kai-Jie Yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gut Microbiota ◽  
Meta Analysis ◽  
Protein Diet ◽  
Low Protein Diet ◽  
International Studies ◽  
Low Protein

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

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 957 ◽  
Author(s):  
Albert Li ◽  
Hsiang-Yen Lee ◽  
Yen-Chung Lin
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein ◽  
Randomized Control ◽  
Very Low Protein Diet ◽  
Restricted Protein Diet

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.

scholarly journals Effect of Low-Protein Diet and Inulin on Microbiota and Clinical Parameters in Patients with Chronic Kidney Disease

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 3006 ◽  
Author(s):  
Silvia Lai ◽  
Alessio Molfino ◽  
Massimo Testorio ◽  
Adolfo M. Perrotta ◽  
Annachiara Currado ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gut Microbiota ◽  
Gut Microbiome ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Therapeutic Effects ◽  
Clinical Parameters ◽  
Low Protein ◽  
Significant Difference

Introduction: The gut microbiota has coevolved with humans for a mutually beneficial coexistence and plays an important role in health and disease. A dysbiotic gut microbiome may contribute to progression to chronic kidney disease (CKD) and CKD-related complications such as cardiovascular disease. Microbiota modulation through the administration of prebiotics may represent an important therapeutic target. Aim: We sought to evaluate the effects of a low-protein diet (LPD) (0.6 g/kg/day) with or without the intake of the prebiotic inulin (19 g/day) on microbiota and clinical parameters in CKD patients. Materials and Methods: We performed a longitudinal, prospective, controlled, and interventional study on 16 patients: 9 patients treated with LPD (0.6 g/kg/day) and inulin (19 g/day) and 7 patients (control group) treated only with LPD (0.6 g/kg/day). Clinical evaluations were performed and fecal samples were collected for a subsequent evaluation of the intestinal microbiota in all patients. These tests were carried out before the initiation of LPD, with or without inulin, at baseline (T0) and at 6 months (T2). The microbiota of 16 healthy control (HC) subjects was also analyzed in order to identify potential dysbiosis between patients and healthy subjects. Results: Gut microbiota of CKD patients was different from that of healthy controls. The LPD was able to significantly increase the frequencies of Akkermansiaceae and Bacteroidaceae and decrease the frequencies of Christensenellaceae, Clostridiaceae, Lactobacillaceae, and Pasteurellaceae. Only Bifidobacteriaceae were increased when the LPD was accompanied by oral inulin intake. We showed a significant reduction of serum uric acid (SUA) and C-reactive protein (CRP) in patients treated with LPD and inulin (p = 0.018 and p = 0.003, respectively), an improvement in SF-36 (physical role functioning and general health perceptions; p = 0.03 and p = 0.01, respectively), and a significant increase of serum bicarbonate both in patients treated with LPD (p = 0.026) or with LPD and inulin (p = 0.01). Moreover, in patients treated with LPD and inulin, we observed a significant reduction in circulating tumor necrosis factor alpha (TNF-α) (p = 0.041) and plasma nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX2) (p = 0.027) levels. We did not find a significant difference in the circulating levels of Interleukin (IL)-1β (p = 0.529) and IL-6 (p = 0.828) in the two groups. Conclusions: LPD, associated or not with inulin, modified gut microbiota and modulated inflammatory and metabolic parameters in patients with CKD. Our results suggest that interventions attempting to modulate the gut microbiome may represent novel strategies to improve clinical outcomes in CKD patients and may provide useful therapeutic effects.

Does Low-Protein Diet Influence the Uremic Toxin Serum Levels From the Gut Microbiota in Nondialysis Chronic Kidney Disease Patients?

2018 ◽  
Vol 28 (3) ◽  
pp. 208-214 ◽  
Author(s):  
Ana Paula Black ◽  
Juliana S. Anjos ◽  
Ludmila Cardozo ◽  
Flávia L. Carmo ◽  
Carla J. Dolenga ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gut Microbiota ◽  
Serum Levels ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Uremic Toxin ◽  
Low Protein

Economic Effects of Treatment of Chronic Kidney Disease with Low-Protein Diet

2013 ◽  
Author(s):  
Francesco Saverio Mennini ◽  
Simone Russo ◽  
Andrea Marcellusi ◽  
Giuseppe Quintaliani ◽  
Denis Fouque
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Economic Effects ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals SP400VERY LOW PROTEIN DIET REDUCES SERUM LEVELS OF INDOXYL SULFATE AND P-CRESYL SULFATE IN CHRONIC KIDNEY DISEASE

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii253-iii253 ◽  
Author(s):  
Maria Teresa Rocchetti ◽  
Carmela Cosola ◽  
Ighli di Bari ◽  
Lucia Di Micco ◽  
Emanuele De Simone ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Levels ◽  
Indoxyl Sulfate ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

2020 ◽  
Author(s):  
Kamyar Kalantar-Zadeh ◽  
Shivam Joshi ◽  
Rebecca Schlueter ◽  
Joanne L. Cooke ◽  
Amanda Brown-Tortorici ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Risk ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Uremic Toxin ◽  
Functional Impairments ◽  
Ckd Progression ◽  
Meat Intake ◽  
Low Protein

Chronic kidney disease (CKD) affects &gt;10% of the adult population. Each year approximately 120,000 Americans develop end-stage kideny disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6-0.8 g/kg/day comprised of &gt;50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, can be promising. The scientific premise of the PLADO is based on the observations that high protein diets with high meat intake are not only associated with higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of hyperkalemia, given constipation from the typical low fiber intake. Plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk in CKD patients. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.

scholarly journals The low-protein diet for chronic kidney disease: 8 years of clinical experience in a nephrology ward

2019 ◽  
Vol 13 (2) ◽  
pp. 253-260 ◽  
Author(s):  
Ivano Baragetti ◽  
Ilaria De Simone ◽  
Cecilia Biazzi ◽  
Laura Buzzi ◽  
Francesca Ferrario ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Independent Predictor ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein ◽  
Stage 4 ◽  
Ckd Stage ◽  
Severe Chronic Kidney Disease

Abstract Background Guidelines indicate that a low-protein diet (LPD) delays dialysis in severe chronic kidney disease (CKD). We assessed the value of these guidelines by performing a retrospective analysis in our renal clinical practice. Methods The analysis was performed from 1 January 2010 to 31 March 2018 in 299 CKD Stage 4 patients followed for 70 months in collaboration with a skilled nutritionist. The patients included 43 patients on a controlled protein diet (CPD) of 0.8 g/kg/day [estimated glomerular filtration rate (eGFR) 20–30 mL/min/1.73 m2 body surface (b.s.)], 171 patients on an LPD of 0.6 g/kg/day and 85 patients on an unrestricted protein diet (UPD) who were not followed by our nutritionist (LPD and UPD, eGFR &lt;20 mL/min/1.73 m2 b.s.). Results eGFR was higher in CPD patients than in UPD and LPD patients (21.9 ± 7.4 mL/min/1.73 m2 versus 17.6 ± 8.00 mL/min/1.73 m2 and 17.1 ± 7.5 mL/min/1.73 m2; P = 0.008). The real daily protein intake was higher in UPD patients than in LPD and CDP patients (0.80 ± 0.1 g/kg/day versus 0.6 ± 0.2 and 0.63 ± 0.2 g/kg/day; P = 0.01). Body mass index (BMI) was stable in the LPD and CPD groups but decreased from 28.5 ± 4.52 to 25.4 ± 3.94 kg/m2 in the UPD group (P &lt; 0.001). The renal survival of UPD, LPD and CPD patients was 47.1, 84.3 and 90.7%, respectively, at 30 months (P &lt; 0.001), 42.4, 72.0 and 79.1%, respectively, at 50 months (P &lt; 0.001) and 42.4, 64.1 and 74.4%, respectively, at 70 months (P &lt; 0.001). The LPD patients started dialysis nearly 24 months later than the UPD patients. Diet was an independent predictor of dialysis [−67% of RR reduction (hazard ratio = 0.33; confidence interval 0.22–0.48)] together with a reduction in BMI. Conclusions An LPD recommended by nephrologists in conjunction with skilled dietitians delays dialysis and preserves nutritional status in severe CKD.

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