Adopting a restricted protein diet supplemented with keto analogues may help prevent secondary hyperparathyroidism (SHPT) and malnutrition in patients with end-stage renal disease (ESRD), according to Chinese researchers.

Wei Qin, MD, of Sichuan University in China, and collaborators conducted a systematic review and meta-analysis of 5 randomized controlled trials (RCT) published until January 2017 that examined various low protein diets with keto analogues (sLPD) in patients on hemodialysis or peritoneal dialysis. Protein intake varied from 0.6 to 0.8 g/kg/day and keto analogues supplements were typically 12 pills/day or 0.12 g/kg/day.

Compared with a normal protein diet, sLPD improved serum albumin (mean difference [MD], 3.84) while avoiding hyperparathyroidism (MD -212.4), and hyperphosphatemia (MD -0.37), the study found. Calcium levels also were better with sLPD (MD 0.1). The team found no beneficial effects of sLPD on anemia or inflammatory status. They observed no adverse changes in triglycerides, cholesterol, hemoglobin, Kt/v, or C-reactive protein.

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“For ESRD patients undergoing maintenance dialysis treatment, the current study confirms that sLPD could be beneficial to mineral bone disease by decreasing serum phosphorus, PTH level and avoiding hypocalcemia,” Dr Qin and colleagues commented in an online report in International Urology and Nephrology. The team found sLPD similarly beneficial in their previous meta-analysis of stage 3 to 5 chronic kidney disease patients.

Limitations of the current analysis included the small number of trials, single-center design, small sample sizes, short follow-up, and limited nutritional information.

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Jiang Z, Tang Y,  Yang L, Mi X, and Qin W. Effect of restricted protein diet supplemented with keto analogues in end‑stage renal disease: a systematic review and meta‑analysis. Int Urol Nephrol. doi: 10.1007/s11255-017-1713-9