title: Keto-supplemented Low Protein Diet: A Valid Therapeutic Approach for Patients with Steroid-resistant Proteinuria during Early-stage Chronic Kidney Disease.
abstract: OBJECTIVE
  Low protein diets supplemented with keto acid (sLPD) are recommended for patients with stage 3-5 chronic kidney disease (CKD). This study assessed whether sLPD is beneficial for patients with steroid-resistant proteinuria during early-stage CKD.
  
  
  METHODS
  A 1-year randomized controlled trial was conducted from 2010 to 2012. In this study, 108 proteinuric patients who were steroid-resistant were assigned to a sLPD group (0.6 g/kg/d with 0.09 g/kg/d keto acids) or a normal protein diet group (NPD, 1.0 g/kg/d). Estimated dietary protein intake, urinary protein excretion, remission rate, renal function, nutritional status, and blood pressure were measured.
  
  
  RESULTS
  Baseline characteristics were comparable between the sLPD group (47 patients) and the NPD group (49 patients). Urinary protein excretion significantly decreased in sLPD compared to NPD in months 6, 9, and 12 (P<0.05). Proteinuria reduction was higher in sLPD than in NPD (P<0.001) at the end of the study. Complete remission and partial remission rates were higher in sLPD than in NPD. Serum albumin and pre-albumin levels were higher in sLPD than in NPD in months 9 and 12 (P<0.05). Serum total cholesterol and triglyceride levels declined more significantly in sLPD than in NPD (P<0.01) at the end of the study. There were no differences in nutritional status, renal function, hemoglobin, or blood pressure between the two groups.
  
  
  CONCLUSIONS
  sLPD is both nutritionally safe and beneficial, providing nephroprotective effects for early-stage CKD patients with steroid-resistant proteinuria.
authors.affiliation: Hongli Lin, MD, Nephrology Department, the First Affiliated Hospital of Dalian Medical University, 222 ZhongShan Road, Dalian 116011 China. Email: linhongli@vip.163.com Telephone: 0086-13332268576.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: H
authors.initials: H
authors.lastname: Xie
authors.forename: M
authors.initials: M
authors.lastname: Fang
authors.forename: K
authors.initials: K
authors.lastname: Wang
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.forename: W
authors.initials: W
authors.lastname: Sun
authors.forename: L
authors.initials: L
authors.lastname: Yang
authors.forename: H
authors.initials: H
authors.lastname: Lin
mesh_terms: D001774:Blood Chemical Analysis; D018753:Diet, Protein-Restricted; D019587:Dietary Supplements / Q000009:adverse effects; D005260:Female; D006801:Humans; D007651:Keto Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D020011:Protective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D011507:Proteinuria / Q000150:complications* / Q000178:diet therapy* / Q000188:drug therapy / Q000652:urine; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000178:diet therapy* / Q000652:urine; D012709:Serum Albumin / Q000032:analysis
chemical_list: D007651:Keto Acids; D020011:Protective Agents; D012709:Serum Albumin