{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:47:07Z","timestamp":1790362027674,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005795","name":"Chang Gung Memorial Hospital, Linkou","doi-asserted-by":"crossref","award":["CMRPG5N0041"],"award-info":[{"award-number":["CMRPG5N0041"]}],"id":[{"id":"10.13039\/501100005795","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>The combined effect of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and KA-AA\u2013supplemented low-protein diets has rarely been studied.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            This cohort included 1729 type 2 diabetes mellitus patients with eGFR \u226430 ml\/min per 1.73 m\n                            <jats:sup>2<\/jats:sup>\n                            who newly received KA-AA supplemented low protein diet (sLPD), with or without SGLT2is.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The combination of SGLT2is and KA-AA sLPD is linked to lower all-cause and cardiovascular disease mortality than KA-AA sLPD alone.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The combination of a supplemented low protein diet (sLPD) with ketoacid analogs and amino acids (KA-AA)\u2014which has been shown to be safe for patients with diabetic kidney disease in some previous studies\u2014and the antidiabetic sodium-glucose cotransporter-2 inhibitors (SGLT2is)\u2014known for their cardiovascular and kidney-protective effects\u2014may represent a treatment strategy for patients with advanced diabetic kidney disease. However, this combination has rarely been investigated in previous studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included a total of 1729 adult patients with type 2 diabetes mellitus with an eGFR \u226430 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      and newly received sLPD treatment. We then divided the patients into two groups on the basis of whether they received a combination of KA-AA and SGLT2is (combination group) or KA-AA alone (KA-AA group). Inverse probability of treatment weighting was performed to balance baseline characteristics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At the 3-year follow-up, compared with the KA-AA group, the combination group exhibited significantly lower risks of all-cause death (16% versus 27%; hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.61 to 0.87), composite of all-cause death and ESKD (54% versus 63%; subdistribution HR, 0.84; 95% CI, 0.75 to 0.93), and cardiovascular death (7% versus 12%; subdistribution HR, 0.68; 95% CI, 0.52 to 0.89). The risk of new-onset ESKD requiring dialysis and heart failure\u2013related hospitalization did not significantly differ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that the addition of SGLT2is to KA-AA sLPD is associated with lower all-cause and cardiovascular mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000000846","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:00:48Z","timestamp":1759334448000},"page":"22-31","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Combining Ketoacid Analog Supplemented Low-Protein Diets with Sodium-Glucose Cotransporter-2 Inhibitors for Patients with Diabetic Kidney Disease"],"prefix":"10.2215","volume":"21","author":[{"given":"Chieh-Li","family":"Yen","sequence":"first","affiliation":[{"name":"Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"},{"name":"College of medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2974-249X","authenticated-orcid":false,"given":"Pei-Chun","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"},{"name":"College of medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6973-5908","authenticated-orcid":false,"given":"Cheng-Chia","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"},{"name":"College of medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9508-5956","authenticated-orcid":false,"given":"Jia-Jin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"},{"name":"College of medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueh-An","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"},{"name":"College of medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8328-9150","authenticated-orcid":false,"given":"Yi-Ran","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"},{"name":"College of medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0361-6348","authenticated-orcid":false,"given":"Pao-Hsien","family":"Chu","sequence":"additional","affiliation":[{"name":"College of medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3782-8189","authenticated-orcid":false,"given":"Ching-Chung","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"},{"name":"College of medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6614-5427","authenticated-orcid":false,"given":"Yung-Chang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan"},{"name":"College of medicine, Chang Gung University, Taoyuan, 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