Supplements and Their Role in Reducing Chronic Kidney Disease Progression
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Abstract
Conservative treatment of chronic kidney disease, apart from simply treating symptoms and associated complications, consists in slowing chronic kidney disease progression, in order to improve patient and family quality of life, to postpone the need for renal replacement therapy and to reduce the treatment costs. Slowing chronic kidney disease progression involves therapeutic strategies, aiming to avoid/treat malnutrition and inflammation, correct anemia, treat mineral bone disorders of CKD and correct vitamin, mineral and microelement’s deficit. This review aims to shed light to the rationale behind these strategies through evidence from clinical studies and the recent guideline recommendations for use of ketoanalogues, essential aminoacids, calcium, Vit D3, iron, Vit
B12, folates and unsaturated fatty acid supplements.
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References
I. Koppe L, Nyam E, Vivot K, Manning Fox JE, Dai XQ, Nguyen BN, Trudel D, Attané C, Moullé VS, MacDonald PE, Ghislain J, Poitout V. Urea impairs β cell glycolysis and insulin secretion in chronic kidney disease. J Clin Invest. 2016 Sep 1;126(9):3598-612. doi: 10.1172/JCI86181.
II. Ramezani A, Massy ZA, Meijers B, Evenepoel P, Vanholder R, Raj DS. Role of the Gut Microbiome in Uremia: A Potential Therapeutic Target. Am J Kidney Dis. 2016 Mar;67(3):483-98. doi: 10.1053/j.ajkd.2015.09.027
III. Shah AP, Kalantar-Zadeh K, Kopple JD. Is there a role for ketoacid supplements in the management of CKD? Am J Kidney Dis. 2015 May;65(5):659-73. doi: 10.1053/j.ajkd.2014.09.029
IV. Fouque D, Chen J, Chen W, Garneata L, Hwang SJ, Kalantar-Zadeh K, Kopple JD, Mitch WE, Piccoli G, Teplan V, Chauveau P. Adherence to ketoacids/essential amino acids-supplemented low protein diets and new indications for patients with chronic kidney disease. BMC Nephrol. 2016 Jul 7;17(1):63. doi: 10.1186/s12882-016-0278-7
V. Lindenau K, Kokot F, Fröhling PT. Suppression of parathyroid hormone by therapy with a mixture of keto analogues/amino acids in hemodialysis patients. Nephron. 1986;43(2):84-6. doi: 10.1159/000183804.
VI. Duan Y, Li F, Li Y, Tang Y, Kong X, Feng Z, Anthony TG, Watford M, Hou Y, Wu G, Yin Y. The role of leucine and its metabolites in protein and energy metabolism. Amino Acids. 2016 Jan;48(1):41-51. doi: 10.1007/s00726-015-2067-1
VII. Teplan V, Schück O, Votruba M, Poledne R, Kazdová L, Skibová J, Malý J. Metabolic effects of keto acid-amino acid supplementation in patients with chronic renal insufficiency receiving a low-protein diet and recombinant human erythropoietin--a randomized controlled trial. Wien Klin Wochenschr. 2001 Sep 17;113(17-18):661-9. PMID: 11603100.
VIII. Wang D, Wei L, Yang Y, Liu H. Dietary supplementation with ketoacids protects against CKD-induced oxidative damage and mitochondrial dysfunction in skeletal muscle of 5/6 nephrectomised rats. Skelet Muscle. 2018;8(1):18. doi.org/10.1186/s13395-018-0164-z
IX. Mitch WE, Walser M, Steinman TI, Hill S, Zeger S, Tungsanga K. The effect of a keto acid-amino acid supplement to a restricted diet on the progression of chronic renal failure. N Engl J Med. 1984 Sep 6;311(10):623-9.
doi: 10.1056/NEJM198409063111002.
X. Aparicio M, Bellizzi V, Chauveau P, Cupisti A, Ecder T, Fouque D, Garneata L, Lin S, Mitch W, Teplan V, Yu X, Zakar G. Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients? Semin Dial. 2013 Nov-Dec;26(6):714-9. doi: 10.1111/sdi.12132
XI. Ikizler TA, Burrowes JD, Byham-Gray LD, et al; KDOQI Nutrition in CKD Guideline Work Group. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis. 2020;76(3) (suppl 1): S1-S107.
doi: 10.1053/j.ajkd.2020.05.006
XII. Chen JB C B, Kao TW. A comparison of progression of chronic renal failure: low dose vs standard dose ketoacids. Kidney Res Clin Pract. 2012;(2):A24 doi.org/10.1016/j.krcp.2012.04.357
XIII. Wu CH, Yang YW, Hung SC, et al. Ketoanalogues supplementation decreases dialysis and mortality risk in patients with anemic advanced chronic kidney disease. PLoS One. 2017;12(5) doi: 10.1371/journal.pone.0176847
XIV. Bergström J, Fürst P, Norée LO. Treatment of chronic uremic patients with protein-poor diet and oral supply of essential amino acids. I. Nitrogen balance studies. Clin Nephrol. 1975;3(5):187-94. PMID: 1149343.
XV. Alvestrand A, Ahberg M, Fùrst P, Bergström J. Clinical results of long term treatment with low protein diet and a new aminoacid preparation in patients with chronic uremia. Clin Nephrol 1983 Feb;19(2):67-73. PMID: 6839554.
XVI. Jiang Z, Zhang X, Yang L, Li Z, Qin W. Effect of restricted protein diet supplemented with keto analogues in chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol. 2016 Mar;48(3):409-18. doi: 10.1007/s11255-015-1170-2
XVII. Chauveau P, Couzi L, Vendrely B, de Précigout V, Combe C, Fouque D, Aparicio M. Long-term outcome on renal replacement therapy in patients who previously received a keto acid-supplemented very-low-protein diet. Am J Clin Nutr. 2009 Oct;90(4):969-74.
doi: 10.3945/ajcn.2009.27980
XVIII. Bellizzi V, Chiodini P, Cupisti A, Viola BF, Pezzotta M, De Nicola L, Minutolo R, Barsotti G, Piccoli GB, Di Iorio B. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrol Dial Transplant. 2015 Jan;30(1):71-7. doi: 10.1093/ndt/gfu251
XIX. Chang JH, Kim DK, Park JT, Kang EW, Yoo TH, Kim BS, Choi KH, Lee HY, Han DS, Shin SK. Influence of ketoanalogs supplementation on the progression in chronic kidney disease patients who had training on low-protein diet. Nephrology (Carlton). 2009 Dec;14(8):750-7. doi.org/10.1111/j.1440-1797.2009.01115.x
XX. Walser M, Hill S, Tomalis EA. Treatment of nephrotic adults with a supplemented, very low-protein diet. Am J Kidney Dis. 1996 Sep;28(3):354-64. doi: 10.1016/s0272-6386(96)90492-8
XXI. Zhang J, Xie H, Fang M, Wang K, Chen J, Sun W, Yang L, Lin H. Keto-supplemented Low Protein Diet: A Valid Therapeutic Approach for Patients with Steroid-resistant Proteinuria during Early-stage Chronic Kidney Disease. J Nutr Health Aging. 2016 Apr;20(4):420-7.
doi: 10.1007/s12603-015-0612-y
XXII. Bolasco P, Caria S, Cupisti A, Secci R, Saverio Dioguardi F. A novel amino acids oral supplementation in hemodialysis patients: a pilot study. Ren Fail. 2011;33(1):1-5.
doi: 10.3109/0886022X.2010.536289.
XXIII. D'Alessandro C, Rossi A, Innocenti M, Ricchiuti G, Bozzoli L, Sbragia G, Meola M, Cupisti A. Dietary protein restriction for renal patients: don't forget protein-free foods. J Ren Nutr. 2013 Sep;23(5):367-71. doi: 10.1053/j.jrn.2012.12.006
XXIV. Spiegel DM, Brady K. Calcium balance in normal individuals and in patients with chronic kidney disease on low- and high-calcium diets. Kidney Int. 2012 Jun;81(11):1116-22.
doi: 10.1038/ki.2011.490.
XXV. Bosworth C, de Boer IH, Targher G, Kendrick J, Smits G, Chonchol M. The effect of combined calcium and cholecalciferol supplementation on bone mineral density in elderly women with moderate chronic kidney disease. Clin Nephrol. 2012 May;77(5):358-65. doi: 10.5414/CN107180
XXVI. Kandula P, Dobre M, Schold JD, Schreiber MJ Jr, Mehrotra R, Navaneethan SD. Vitamin D supplementation in chronic kidney disease: a systematic review and meta-analysis of observational studies and randomized controlled trials. Clin J Am Soc Nephrol. 2011 Jan;6(1):50-62. doi: 10.2215/CJN.03940510.
XXVII. Morrone LF, Bolasco P, Camerini C, Cianciolo G, Cupisti A, Galassi A, Mazzaferro S, Russo D, Russo L, Cozzolino M. Vitamin D in patients with chronic kidney disease: a position statement of the Working Group "Trace Elements and Mineral Metabolism" of the Italian Society of Nephrology. J Nephrol. 2016 Jun;29(3):305-328.
doi: 10.1007/s40620-016-0305-6
XXVIII. de Boer IH, Zelnick LR, Ruzinski J, et al. Effect of Vitamin D and Omega-3 Fatty Acid Supplementation on Kidney Function in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA. 2019;322(19):1899–1909.
doi: 10.1001/jama.2019.17380
XXIX. Manson JE, Bassuk SS, Lee IM, et al. The Vitamin D and Omega-3 Trial (VITAL): rationale and design of a large randomized controlled trial of vitamin D and marine omega-3 fatty acid supplements for the primary prevention of cancer and cardiovascular disease. Contemp Clin Trials. 2012;33(1):159-171.
doi: 10.1016/j.cct.2011.09.009.
XXX. Huang X, Lindholm B, Stenvinkel P, Carrero JJ. Dietary fat modification in patients with chronic kidney disease: n-3 fatty acids and beyond. J Nephrol. 2013 Nov-Dec;26(6):960-74.
doi: 10.5301/jn.5000284.
XXXI. Mas E, Barden A, Burke V, Beilin LJ, Watts GF, Huang RC, Puddey IB, Irish AB, Mori TA. A randomized controlled trial of the effects of n-3 fatty acids on resolvins in chronic kidney disease. Clin Nutr. 2016 Apr;35(2):331-336.
doi: 10.1016/j.clnu.2015.04.004.
XXXII. Barden AE, Burke V, Mas E, Beilin LJ, Puddey IB, Watts GF, Irish AB, Mori TA. n-3 fatty acids reduce plasma 20-hydroxyeicosatetraenoic acid and blood pressure in patients with chronic kidney disease. J Hypertens. 2015 Sep;33(9):1947-53. doi: 10.1097/HJH.0000000000000621.
XXXIII. Barden A, O'Callaghan N, Burke V, Mas E, Beilin LJ, Fenech M, Irish AB, Watts GF, Puddey IB, Huang RC, Mori TA. n-3 Fatty Acid Supplementation and Leukocyte Telomere Length in Patients with Chronic Kidney Disease. Nutrients. 2016 Mar 19;8(3):175.
doi: 10.3390/nu8030175
XXXIV. Kovesdy CP, Kalantar-Zadeh K. Iron therapy in chronic kidney disease: current controversies. J Ren Care. 2009 Dec;35 Suppl 2:14-24. doi: 10.1111/j.1755-6686.2009.00125.x
XXXV. Babitt JL, Eisenga MF, Haase VH, et al. Controversies in optimal anemia management: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney Int. 2021;99(6):1280-1295.
doi: 10.1016/j.kint.2021.03.020.
XXXVI. Roger SD, Gaillard CA, Bock AH, et al. Safety of intravenous ferric carboxymaltose versus oral iron in patients with nondialysis-dependent CKD: an analysis of the 1-year FIND-CKD trial. Nephrol Dial Transplant. 2017;32(9):1530-1539. doi: 10.1093/ndt/gfw264.
XXXVII. Ponikowski P, Filippatos G, Colet JC, et al. The impact of intravenous ferric carboxymaltose on renal function: an analysis of the FAIR-HF study. Eur J Heart Fail. 2015;17(3):329-339.
doi: 10.1002/ejhf.229.
XXXVIII. Xu X, Qin X, Li Y, et al. Efficacy of folic acid therapy on the progression of chronic kidney disease: the renal substudy of the China Stroke Primary Prevention Trial. JAMA Intern Med. 2016;176(10):1443-1450.
doi: 10.1001/jamainternmed.2016.4687
XXXIX. Jamison RL, Hartigan P, Kaufman JS, et al. Effect of ho- mocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: a randomized controlled trial. JAMA. 2007;298(10):1163-1170. doi: 10.1001/jama.298.10.1163
XL. Bostom AG, Carpenter MA, Kusek JW, et al. Homocysteine- lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial. Circulation. 2011;123(16):1763- 1770.
doi: 10.1161/CIRCULATIONAHA.110.000588