Li Donglai, Dawson Jessica, Gunton Jenny E
Centre for Diabetes, Obesity and Endocrinology Research (CDOER), Westmead Institute for Medical Research, Westmead, Sydney, NSW 2145, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2066, Australia.
Nutrients. 2024 Dec 31;17(1):145. doi: 10.3390/nu17010145.
Recent findings have highlighted that abnormal energy metabolism is a key feature of autosomal-dominant polycystic kidney disease (ADPKD). Emerging evidence suggests that nutritional ketosis could offer therapeutic benefits, including potentially slowing or even reversing disease progression. This systematic review aims to synthesise the literature on ketogenic interventions to evaluate the impact in ADPKD.
A systematic search was conducted in Medline, Embase, and Scopus using relevant Medical Subject Headings (MeSH) and keywords. Studies assessing ketogenic interventions in the management of ADPKD in both human and animal models were selected for data extraction and analysis.
Three animal reports and six human studies were identified. Ketogenic diets (KD) significantly slowed polycystic kidney disease (PKD) progression in rats with improved renal function and reduced cystic areas. There was reduced renal fibrosis and cell proliferation. The supplementation of beta-hydroxybutyrate (BHB) in rats also reduced PKD progression in a dose-dependent manner. Human studies ( = 129) on KD in ADPKD reported consistent body mass index (BMI) reduction across trials, with an average weight loss of ∼4 kg. Improvements in blood pressure were also noted. Ketosis was achieved in varying degrees. Effects on kidney function (eGFR) were beneficial. Results for kidney volume were mixed but most studies were underpowered for this outcome. Lipid profiles showed increases in total cholesterol (∼1 mmol/L) and LDL cholesterol (∼0.4 mmol/L) in most studies. Safety concerns such as "keto flu" symptoms, elevated uric acid levels, and occasional kidney stones were noted. Overall feasibility and adherence to the KD were rated positively by most participants.
Human studies are promising; however, they have been limited by small sample sizes and short durations. Larger, long-term trials are needed to assess the efficacy, adherence, and safety of ketogenic diets in people with ADPKD.
最近的研究结果突出表明，能量代谢异常是常染色体显性多囊肾病（ADPKD）的一个关键特征。新出现的证据表明，营养性生酮可能具有治疗益处，包括有可能减缓甚至逆转疾病进展。本系统评价旨在综合关于生酮干预措施的文献，以评估其对ADPKD的影响。
使用相关医学主题词（MeSH）和关键词在Medline、Embase和Scopus中进行系统检索。选择评估生酮干预措施在人类和动物模型中对ADPKD管理效果的研究进行数据提取和分析。
共识别出3篇动物报告和6项人类研究。生酮饮食（KD）显著减缓了大鼠多囊肾病（PKD）的进展，肾功能得到改善，囊性区域减小。肾纤维化和细胞增殖减少。在大鼠中补充β-羟基丁酸（BHB）也以剂量依赖的方式降低了PKD的进展。关于ADPKD患者KD的人类研究（n = 129）报告称，各试验中体重指数（BMI）持续降低，平均体重减轻约4千克。还注意到血压有所改善。不同程度地实现了酮症。对肾功能（估算肾小球滤过率[eGFR]）的影响是有益的。肾脏体积的结果不一，但大多数研究针对该结果的样本量不足。大多数研究中脂质谱显示总胆固醇（约1 mmol/L）和低密度脂蛋白胆固醇（约0.4 mmol/L）升高。注意到一些安全问题，如“酮流感”症状、尿酸水平升高和偶尔出现肾结石。大多数参与者对KD的总体可行性和依从性评价良好。
人类研究前景良好；然而，它们受到样本量小和持续时间短的限制。需要进行更大规模的长期试验，以评估生酮饮食对ADPKD患者的疗效、依从性和安全性。
Zotero 插件