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Open AccessArticle

Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis?

1
Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan
2
College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(11), 3358; https://doi.org/10.3390/nu12113358
Received: 7 October 2020 / Revised: 25 October 2020 / Accepted: 29 October 2020 / Published: 31 October 2020
(This article belongs to the Special Issue Dietary Interventions in Chronic Kidney Disease)
Background: Previous studies have demonstrated that dietary therapy can delay the initiation of dialysis, but little research has investigated whether patients with very poor renal function would benefit from a dietary therapy. Methods: This study was performed by using the Chang Gung Research Database (CGRD), which is based on the largest medical system in Taiwan. Patients with estimated glomerular filtration rates (eGFR) < 15 mL/min/1.73 m2 between 2001 and 2015 with more than 3 months of low-protein diet supplemented with ketoanalogues (sLPD) were extracted (Ketosteril group). We then assigned five patients without any sLPD to match one patient of the Ketosteril group (comparison group). Both groups were followed up for 1 year for the initiation of dialysis and rates of major adverse cardiac and cerebrovascular events (MACCEs). Results: The Ketosteril group (n = 547), compared with the comparison group (n = 2735), exhibited a lower incidence of new-onset dialysis (40.2% vs. 44.4%, subdistribution hazard ratio (SHR): 0.80, 95% confidence interval (CI): 0.70–0.91) and MACCEs (3.7% vs. 5.9%, HR: 0.61, 95% CI: 0.38–0.97). The beneficial effect of an sLPD did not differ in patients with a baseline eGFR < 5 mL/min/1.73 m2. Conclusion: Even among patients with extremely low eGFR, sLPD treatment can safely delay the need for dialysis. View Full-Text
Keywords: chronic kidney disease; Ketosteril; low-protein diet; dialysis; adverse events chronic kidney disease; Ketosteril; low-protein diet; dialysis; adverse events
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MDPI and ACS Style

Yen, C.-L.; Fan, P.-C.; Lee, C.-C.; Kuo, G.; Tu, K.-H.; Chen, J.-J.; Lee, T.-H.; Hsu, H.-H.; Tian, Y.-C.; Chang, C.-H. Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis? Nutrients 2020, 12, 3358.

AMA Style

Yen C-L, Fan P-C, Lee C-C, Kuo G, Tu K-H, Chen J-J, Lee T-H, Hsu H-H, Tian Y-C, Chang C-H. Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis? Nutrients. 2020; 12(11):3358.

Chicago/Turabian Style

Yen, Chieh-Li; Fan, Pei-Chun; Lee, Cheng-Chia; Kuo, George; Tu, Kun-Hua; Chen, Jia-Jin; Lee, Tao-Han; Hsu, Hsiang-Hao; Tian, Ya-Chun; Chang, Chih-Hsiang. 2020. "Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis?" Nutrients 12, no. 11: 3358.

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