Protein Restriction Effective in Delaying Need for Dialysis, Comprehensive Study Shows

AUSTIN, TX — April 11, 2018 —Low-protein diets can delay kidney failure in patients with chronic kidney disease (CKD), according to a new comprehensive, systematic review presented at the National Kidney Foundation 2018 Spring Clinical Meetings in Austin, Texas.

 

But the review found unclear evidence to support the practice of treating CKD by supplementing very low protein diets with keto-analogs. Recent research examining the efficacy of these two widespread treatments had previously yielded conflicting results. This assessment involved a systematic review and meta-analysis of more than two dozen clinical trials over 30 years.

 

“Current evidence indicates that protein restriction can help delay dialysis initiation and lower mortality risk. However, medical team supervision and monitoring of patients’ nutritional status is important,” said Dr. Deepa Handu, one of the researchers involved in this collaborative project between the Academy of Nutrition and Dietetics and the National Kidney Foundation.

Chronic kidney disease is a leading cause of death among adults. Treatments such as dialysis, which artificially replaces the kidneys’ blood-filtering function, can prolong life, but can also reduce patients’ quality of life.

 

Protein restriction diets have long been thought to be beneficial to patients with CKD by delaying the kidneys’ decline and thus delaying the need for dramatic interventions like dialysis. Some treatment plans also call for supplementing the diet with keto-analogs to maintain healthy nutrition. Keto-analogs can be used to build proteins in the body but require less work from the kidneys compared to proteins found in the diet.

 

To get a clearer picture of how well protein restriction and keto-analog supplementation work, the authors looked at the results of 27 controlled trials spanning three decades, from 1985 to 2016. 

Of the studies, identified on PubMed and Ovid/MEDLINE, 13 examined the impact of protein restriction in delaying the initiation of dialysis, and 14 analyzed protein restriction combined with keto-analog supplementation. The authors extracted and summarized relevant data, analyzed the data for bias, and used meta-analysis where appropriate.

Pooled analysis showed a statistically significant beneficial effect of protein restriction in delaying the need for dialysis in adults with CKD. However, studies comparing protein restriction and keto-analog supplementation in adults with advanced CKD (stage three or beyond) report an unclear effect.

 

An article detailing the study’s findings has been accepted for publication in the American Journal of Kidney Diseases. The researchers involved in the study include Denis Fouque, Centre Hospitalier Lyon-Sud, Lyon, France; Alp Ikizler, Vanderbilt University School of Medicine, Nashville, TN; Lilian Cuppari, Disciplina de Nefrologia, UNIFESP/EPM, São Paulo, Brazil; and Mary Rozga from the Academy of Nutrition and Dietetics, Chicago.

 

For the past 27 years, nephrology healthcare professionals from across the country have come to NKF’s Spring Clinical Meetings to learn about the newest developments related to all aspects of nephrology practice; network with colleagues; and present their research findings. The NKF Spring Clinical Meetings are designed for meaningful change in the multidisciplinary healthcare teams’ skills, performance, and patient health outcomes. It is the only conference of its kind that focuses on translating science into practice for the entire healthcare team. 

 

30 million American adults are estimated to have chronic kidney disease—and most aren’t aware of it. 1 in 3 American adults are at risk for chronic kidney disease. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history of kidney failure. People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease. African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end-stage renal disease (kidney failure).