Bellizzi V, et al. - Researchers assessed the impact of low-protein diet supplemented with ketoacids on nutrition in chronic kidney disease (CKD) diabetics. Intake of such a diet by these subjects resulted in improved uremia and diabetes, sudden decline of body weight which remained stable over time. No negative impact was seen on wasting and muscle mass and fitness. In this patient population, safety of the LPD-KA [low-protein (0.5–0.6 g/kg/d), normal-high energy (30–35 kcal/kg/d) diet supplemented with ketoacids] was demonstrated, with same nutritional impact as has been seen in non-diabetics CKD.

Methods

• This study included CKD patients with (DM) and without (non-DM) diabetes mellitus.
• Prospective evaluation was carried out among study participants for the metabolic and nutritional impacts of a low-protein (0.5–0.6 g/kg/d), normal-high energy (30–35 kcal/kg/d) diet supplemented with ketoacids (LPD-KA).

Results

• Study included a total of 197 patients on CKD stages 3–5.
• DM (n = 81) and non-DM (n = 116) were found to be comparable for gender (Male 58 vs 55%), age (66 ± 9 vs 63 ± 18 years), renal function (eGFR 23 ± 13 vs 24 ± 13 mL/min).
• Decline in serum urea (DM: 131 ± 58 to 105 ± 49 mg/dl, p < 0.05; non-DM: 115 ± 52 to 88 ± 36, p < 0.05) and phosphate (DM: 4.5 ± 1.3 to 4.1 ± 1.2 mg/dl, p=0.06; non-DM: 4.3 ± 1.0 to 3.7 ± 0.8, p < 0.05) was detected after 6-month.
• In DM, decrease in fasting glucose (126 ± 52 to 103 ± 29 mg/dl, p < 0.05) was noted without insulin dose increase.
• No changes occurred in these effects after 3-year.
• No change was found in serum albumin after 6 months (DM: 3.7 ± 0.6 to 3.8 ± 0.4 mg/dl; non-DM: 4.0 ± 0.6 to 4.0 ± 0.4) and in the long-term.
• Following the diet start, decline in body weight (BW) was noted (DM: 68.9 ± 14.3 to 65.1 ± 12.1 kg, p < 0.05; non-DM: 66.6 ± 15.1 to 64.1 ± 15.1, p < 0.05), which was found to be stable at 6 months and 3 years.
• In all patients, reduced muscle strength was reported at baseline and remained stable during the diet period.
• During the study, similar changes of nutritional markers were reported among groups and diabetes was not found to have association with any nutritional change at the multivariate analysis.
• Researchers found that as attain wasting, lower BMI (< 23 kg/m²) and albumin (< 3.8 g/dl) levels were present in 1/3 patients at start and along 3 years, cholesterol never dropped below the lower threshold (< 100 mg/dl) and poorer FM (< 10%) was less than 10% during the study in both groups.