酮体类似物对慢性肾脏病进展的影响：一项荟萃分析。

The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis.

机构信息

Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 111, Taiwan.

Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 111, Taiwan.

出版信息

Nutrients. 2019 Apr 26;11(5):957. doi: 10.3390/nu11050957.

The effects of ketoanalogues (KA) on chronic kidney disease (CKD) deterioration have not yet been fully confirmed. To strengthen the evidence of the role of KA in CKD, PubMed and Embase were searched for studies published through February 2019. Effect sizes from ten randomized control trials (RCTs) and two non-RCTs comprising a total of 951 patients were pooled and analyzed. A restricted protein diet supplemented with ketoanalogues (RPKA) was found to significantly delay the progression of CKD ( = 0.008), particularly in patients with an estimated glomerular filtration rate (eGFR) > 18 mL/min/1.73 m ( < 0.0001). No significant change in eGFR was found when comparing a very-low-protein diet and a low-protein diet ( = 0.10). In addition, compared with the placebo, RPKA did not cause malnutrition (albumin: = 0.56; cholesterol: = 0.50). Moreover, RPKA significantly decreased phosphorous levels ( = 0.001), increased calcium levels ( = 0.04), and decreased parathyroid hormone (PTH) levels ( = 0.05) in patients with eGFR < 18 mL/min/1.73 m. In conclusion, RPKA could slow down the progression of CKD in patients with eGFR > 18 mL/min/1.73 m without causing malnutrition and reverse CKD-MBD in patients with eGFR < 18 mL/min/1.73 m.

Ketoanalogues (KA) 在慢性肾脏病 (CKD) 恶化中的作用尚未得到充分证实。为了加强 KA 在 CKD 中的作用证据，检索了截至 2019 年 2 月发表的文献，检索数据库包括 PubMed 和 Embase。共纳入了 10 项随机对照试验 (RCT) 和 2 项非随机对照试验，共计 951 例患者。结果显示，补充 ketoanalogues 的限制蛋白饮食 (RPKA) 可显著延缓 CKD 进展 ( = 0.008)，尤其在估计肾小球滤过率 (eGFR) > 18 mL/min/1.73 m 的患者中更为显著 ( < 0.0001)。与极低蛋白饮食和低蛋白饮食相比，eGFR 无显著变化 ( = 0.10)。此外，与安慰剂相比，RPKA 并未导致营养不良 (白蛋白： = 0.56；胆固醇： = 0.50)。而且，RPKA 可显著降低 eGFR < 18 mL/min/1.73 m 的患者的血磷水平 ( = 0.001)、升高血钙水平 ( = 0.04)、降低甲状旁腺激素 (PTH)水平 ( = 0.05)。综上，RPKA 可在不导致营养不良的情况下延缓 eGFR > 18 mL/min/1.73 m 的 CKD 患者的疾病进展，并逆转 eGFR < 18 mL/min/1.73 m 的 CKD-MBD 患者的病情。