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CKD: Protein Restriction: VLPD with KAA Supplementation (2018)

Intervention
What is the effect of protein restriction with a VLPD and KAA supplementation on ESRD in adults with CKD 3-5?
- Conclusion
  Dietary protein restriction with keto acid analog (KAA) supplementation has an unclear effect on renal replacement therapy/renal survival in adults with CKD Stages 3 to 5.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction with a VLPD and KAA supplementation on ESRD in adults with CKD 3-5?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018
What is the effect of protein restriction with a VLPD and KAA supplementation on lipid profile in adults with CKD 3-5?
- Conclusion
  Protein restriction with keto acid analog (KAA) supplemetation (0.3-0.4 g with KAA) has an unclear effect on total cholesterol and triglyceride levels in adults with CKD Stages 3 to 5.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction with a VLPD and KAA supplementation on lipid profile in adults with CKD 3-5?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018
What is the effect of protein restriction with a VLPD and KAA supplementation on blood pressure in adults with CKD 3-5?
- Conclusion
  Protein restriction with keto acid analog (KAA) supplementation (0.3-0.4 g with KAA) as an unclear effect on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults with CKD Stages 3 to 5.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction with a VLPD and KAA supplementation on blood pressure in adults with CKD 3-5?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018
What is the effect of protein restriction with a VLPD and KAA supplementation on eGFR in adults with CKD 3-5?
- Conclusion
  Very low protein restricted diets supplemented with keto-analogues (0.28-0.4 g/kg body weight) could help preserve GFR in CKD Stage 3 to 5 patients.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction with a VLPD and KAA supplementation on eGFR in adults with CKD 3-5?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018
What is the effect of protein restriction with a VLPD and KAA supplementation on phosphate levels in adults with CKD 4-5D?
- Conclusion
  Protein restriction supplemented with keto acid analog (KAA) (0.3-0.6 g protein/kg/d with KAA) lowers serum phosphate levels in Stage 4 and 5 CKD patients and maintenance hemodialysis patients.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction with a VLPD and KAA supplementation on phosphate levels in adults with CKD 4-5D?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018
What is the effect of protein restriction with a VLPD and KAA supplementation on anthropometric measures in adults with CKD 3-4?
- Conclusion
  Protein restriction supplemented with keto acid analog (KAA) (0.3 g protein/kg/d with KAA) had unclear effects on anthropometric measures in Stage 3 and 4 CKD patients.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction + KAA supplementation on anthropometric measures in adults with CKD 1-5D, non-dialysis and transplant?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018
What is the effect of protein restriction with a VLPD and KAA supplementation on albumin levels in adults with CKD 3-5D?
- Conclusion
  Protein restriction supplemented with keto acid analog (KAA) (0.3 g protein/kg/d with KAA) had no effect on serum albumin levels and nutritional status as measured by SGA in Stages 3 to 5 CKD patients and peritoneal dialysis patients.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction with a VLPD and KAA supplementation on albumin levels in adults with CKD 3-5D?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018
What is the effect of protein restriction with a VLPD and KAA supplementation on protein intake in adults with CKD 3-5D?
- Conclusion
  A low protein diet supplemented with KAA is achievable and associated with a protein intake lower than control.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction with a VLPD and KAA supplementation on protein intake in adults with CKD 3-5D?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018
What is the effect of protein restriction with a VLPD and KAA supplementation on energy and electrolyte mineral intake in adults with CKD 3-5D?
- Conclusion
  It is unclear if a very low protein diet (VLPD) supplemented with keto acid analog (KAA) is associated with a reduced energy intake. A very low protein intake (0.3 g/kg/day) supplemented with KAA is associated with a lower phosphate intake, a lower salt intake whereas calcium intake is unchanged.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of protein restriction with a VLPD and KAA supplementation on energy and electrolyte mineral intake in adults with CKD 3-5D?
- Search Plan and Results: CKD Macronutrients: Dietary Protein 2018