Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Nov;37(8):2113-2125.
doi: 10.1007/s40620-024-02065-9. Epub 2024 Sep 28.

Efficacy and safety of ketoanalogue supplementation combined with protein-restricted diets in advanced chronic kidney disease: a systematic review and meta-analysis

Chih-Heng Chen  1   2 , Ping-Hsiu Tsai  3 , Wan-Chuan Tsai  3   4 , Mei-Ju Ko  5   6   7 , Le-Yin Hsu  8 , Kuo-Liong Chien  9   8 , Kuan-Yu Hung  10   11 , Hon-Yen Wu  12   13   14   15
Affiliations
Meta-Analysis

Efficacy and safety of ketoanalogue supplementation combined with protein-restricted diets in advanced chronic kidney disease: a systematic review and meta-analysis

Chih-Heng Chen et al. J Nephrol. 2024 Nov.

Abstract

Background: The benefits and harms of protein-restricted diets supplemented with ketoanalogues in patients with chronic kidney disease (CKD) remain uncertain. We aimed to evaluate the effects of ketoanalogues supplemented to protein-restricted diets in patients with advanced CKD.

Methods: We conducted systematic literature searches of PubMed, Embase, Scopus, and Cochrane Library up to June 3, 2024. Randomized controlled trials comparing ketoanalogue supplementation with a low- or very low-protein diet versus a low-protein diet alone in stages 3-5 CKD patients were selected. Outcomes included glomerular filtration rate (GFR), end-stage kidney disease (ESKD), all-cause mortality, and blood levels of urea nitrogen, calcium, phosphorus, and albumin. Triceps skin fold, mid-arm muscle circumference, lean body mass, and subjective global assessment were also evaluated. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42023465754).

Results: A total of 16 trials comprising 1344 participants were identified, with a median follow-up of 13 months. Compared to a low-protein diet alone, ketoanalogues supplemented to a protein-restricted diet resulted in a significantly higher GFR, decreased levels of urea nitrogen and phosphorus, and increased levels of calcium. Furthermore, ketoanalogues combined with a protein-restricted diet showed a marginally lower risk of ESKD in participants without diabetes. No significant differences were observed in all-cause mortality, albumin, mid-arm muscle circumference, lean body mass, and subjective global assessment.

Conclusions: For stages 3-5 CKD patients, ketoanalogues combined with a protein-restricted diet may help postpone initiation of dialysis, improve calcium-phosphate homeostasis, and slow GFR decline, while maintaining a similar nutritional status and survival. Larger, long-term studies are needed to confirm these potential benefits, especially in CKD patients with diabetes.

Keywords: Diet, protein-restricted; Glomerular filtration rate; Ketoanalogues; Renal insufficiency, chronic.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare that there are no competing interests. Ethical approval: Not applicable. This study was a systematic review and meta-analysis based exclusively on published data. Research involving human participants and/or animals: This study was a systematic review and meta-analysis based solely on published data and did not involve any new studies with human or animal subjects conducted by the authors. Informed consent: Not applicable. This study was a systematic review and meta-analysis based exclusively on published data.

References

    1. Tsai WC, Wu HY, Peng YS, Yang JY, Chen HY, Chiu YL et al (2017) Association of intensive blood pressure control and kidney disease progression in nondiabetic patients with chronic kidney disease: a systematic review and meta-analysis. JAMA Intern Med 177(6):792–799. https://doi.org/10.1001/jamainternmed.2017.0197 - DOI - PubMed - PMC
    1. Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V (2021) Chronic kidney disease. Lancet 398(10302):786–802. https://doi.org/10.1016/S0140-6736(21)00519-5 - DOI - PubMed
    1. Lin JJ, Morey F, Wu HY, Yang JY, Peng YS, Mendez D et al (2021) Prevalence and risk factors for chronic kidney disease in belize: a population-based survey. Lancet Reg Health Am 1:100013. https://doi.org/10.1016/j.lana.2021.100013 - DOI - PubMed - PMC
    1. Sundstrom J, Bodegard J, Bollmann A, Vervloet MG, Mark PB, Karasik A et al (2022) Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2.4 million patients from 11 countries: the CaReMe CKD study. Lancet Reg Health Eur 20:100438. https://doi.org/10.1016/j.lanepe.2022.100438 - DOI - PubMed - PMC
    1. Chen IC, Tsai WC, Hsu LY, Ko MJ, Chien KL, Hung KY et al (2024) Association between alcohol consumption and chronic kidney disease: a population-based survey. Clin Exp Nephrol. https://doi.org/10.1007/s10157-024-02515-5 - DOI - PubMed - PMC

Publication types

MeSH terms

LinkOut - more resources