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A Low-Protein Diet for Diabetic Kidney Disease: Its Effect and Molecular Mechanism, an Approach from Animal Studies.

Nutrients
April 27, 2018
Munehiro Kitada et al. (4 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the reno-protective effects of low-protein diets (LPDs), particularly very-low-protein diets (VLPDs), in advanced chronic kidney disease (CKD) and diabetic kidney disease (DKD), focusing on molecular mechanisms and clinical benefits.

Results Summary

The study found that LPDs, especially VLPDs, improve renal function by reducing glomerular hyperfiltration/hypertension and restoring autophagy via mTORC1 inhibition, but noted insufficient clinical data on VLPDs for DKD and highlighted risks of malnutrition in CKD patients.

Population

Patients with advanced CKD, including diabetic kidney disease (DKD), and animal models of type 2 diabetes and obesity.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (6)
InterventionDirectionEndpointPopulationDosageImpactClaim #
low-protein diet (LPD)
decrease
renal function decline
patients in advanced stages of chronic kidney disease (CKD), including diabetic kidney disease (DKD)
-
can be expected to retard
#1
low-protein diet (LPD)
decrease
glomerular hyperfiltration/hypertension
animal models
-
exerts reno-protection through mainly the improvement of
#2
low-protein diet (LPD), particularly a very-LPD (VLPD)
decrease
tubulo-interstitial damage, inflammation and fibrosis
type 2 diabetes and obesity animal models
-
improved
#3
very-LPD (VLPD)
decrease
advanced DKD
animal models
-
may show a more beneficial effect against
#4
very-LPD (VLPD), not a moderate LPD
decrease
renal dysfunction
patients with chronic glomerular nephritis
-
slows the progression of
#5
VLPD replacement therapy without malnutrition
decrease
the advanced stages of DKD
-
-
may be expected for reno-protection against
#6
Abstract

A low-protein diet (LPD) can be expected to retard renal function decline in advanced stages of chronic kidney disease (CKD), including diabetic kidney disease (DKD), and is recommended in a clinical setting. Regarding the molecular mechanisms of an LPD against DKD, previous animal studies have shown that an LPD exerts reno-protection through mainly the improvement of glomerular hyperfiltration/hypertension due to the reduction of intraglomerular pressure. On the other hand, we have demonstrated that an LPD, particularly a very-LPD (VLPD), improved tubulo-interstitial damage, inflammation and fibrosis, through the restoration of autophagy via the reduction of a mammalian target of rapamycin complex 1 (mTORC1) activity in type 2 diabetes and obesity animal models. Thus, based on animal studies, a VLPD may show a more beneficial effect against advanced DKD. Previous clinical reports have also shown that a VLPD, not a moderate LPD, slows the progression of renal dysfunction in patients with chronic glomerular nephritis. However, there is insufficient clinical data regarding the beneficial effects of a VLPD against DKD. Additionally, the patients with CKD, including DKD, are a high-risk group for malnutrition, such as protein⁻energy wasting (PEW), sarcopenia, and frailty. Therefore, an LPD, including a VLPD, should be prescribed to patients when the benefits of an LPD outweigh the risks, upon consideration of adherence, age, and nutritional status. As the future predicts, the development of a VLPD replacement therapy without malnutrition may be expected for reno-protection against the advanced stages of DKD, through the regulation of mTORC1 activity and adequate autophagy induction. However, further studies to elucidate detailed mechanisms by which a VLPD exerts reno-protection are necessary.

Medical Subject Headings (MeSH)
AnimalsAutophagyClinical Decision-MakingDiabetic NephropathiesDiet, Protein-RestrictedDietary ProteinsHumansKidneyMechanistic Target of Rapamycin Complex 1Nutritional StatusPatient SelectionRisk FactorsSignal TransductionTreatment Outcome
Study Links
Quality Scores
Safety70
Efficacy80/10
Quality75/10
Citation Metrics
Total Citations37
Citations/Year5.3
Relative Citation Ratio1.93
NIH Percentile73.5%
Research Impact Scores
APT Score0.75
Weight Score1.07
Normalized Score0.75
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