{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:18:00Z","timestamp":1793085480742,"version":"4.5.0"},"reference-count":48,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017530","name":"Fresenius Kabi","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100017530","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/04rzhfa50","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Fundaci\u00f3n IMSS, A.C.","award":["R-2019-05-08"],"award-info":[{"award-number":["R-2019-05-08"]}]},{"award":["R-2019-05-08"],"award-info":[{"award-number":["R-2019-05-08"]}],"id":[{"id":"https:\/\/ror.org\/03y4g9k62","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Low-protein diets (LPD) and very-low-protein diets supplemented with Ketoanalogues (sVLPD) delay initiation of dialysis in non-diabetic patients with chronic kidney disease (CKD). sVLPD is not recommended in patients with type 2 diabetes mellitus (T2DM), and information about LPD supplemented with Ketoanalogues (LPD + KA) is scarce or inconclusive. The objective of this study is to provide further evidence on the benefits and safety of LPD supplemented with KA (LPD + KA) compared with LPD alone in reducing CKD progression in patients with T2DM. Methods: T2DM patients in stages 3b-4 of CKD (n = 149) were included in a multicenter, randomized, controlled trial and received LPD + KA or LPD, 1 year follow-up. Evaluations were carried out bimonthly. In both groups, protein intake was 0.6 g\/kg\/day, and the LPD + KA group received KA at the recommended dose. The primary outcome was a decline in eGFR, calculated with Creatinine and with Cystatin C. Secondary outcomes were dialysis requirement, deterioration in nutritional status, hospitalization, morbidity, and mortality. Results: During follow-up, protein nitrogen appearance was 0.556 \u00b1 0.119 and 0.576 \u00b1 0.134 g\/kg\/day in LPD + KA and LPD, respectively (p = 0.002). The decrease in eGFRCysC from the baseline was \u22124.29 \u00b1 0.96 mL\/min in LPD + KA and \u22128.54 \u00b1 2.19 mL\/min in LPD (using linear mixed-effects model, p = 0.012). eGFRCr did not show differences. There were no differences in nutrition status, metabolic control, adverse events, hospitalizations, or hospital days. Conclusions: Ketoanalogues slow the decline in eGFRCyC but not eGFRCr in T2DM patients, even without differences in protein intake. LPD + KA may be considered useful and safe; however, due to limitations in sample size and follow-up, as well as observed changes in Cr metabolism, the results warrant confirmation with a more robust design and a longer follow-up period.<\/jats:p>","DOI":"10.3390\/nu18162630","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T11:02:11Z","timestamp":1786532531000},"page":"2630","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Low-Protein Diet Supplemented with Ketoanalogues and Progression of Chronic Kidney Disease in Diabetic Patients: A Multicenter Randomized Controlled Trial"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3577-9707","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Paniagua","sequence":"first","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Enfermedades Nefrol\u00f3gicas, UMAE Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de M\u00e9xico 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8855-9682","authenticated-orcid":false,"given":"Marcela","family":"\u00c1vila-D\u00edaz","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Enfermedades Nefrol\u00f3gicas, UMAE Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de M\u00e9xico 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Nava","sequence":"additional","affiliation":[{"name":"Centro de Atenci\u00f3n Nutricional Fresenius Kabi, Ciudad de M\u00e9xico 11590, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4312-1593","authenticated-orcid":false,"given":"Renata","family":"Romero-Salas","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Enfermedades Nefrol\u00f3gicas, UMAE Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de M\u00e9xico 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos H","family":"Hern\u00e1ndez-Rivera","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Enfermedades Nefrol\u00f3gicas, UMAE Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de M\u00e9xico 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7261-6419","authenticated-orcid":false,"given":"Oliva","family":"Mej\u00eda-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Hospital General de Zona N\u00b0 83, Instituto Mexicano del Seguro Social, Morelia 58070, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgina B","family":"Picolli","sequence":"additional","affiliation":[{"name":"N\u00e9phrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Mexican Nephrology Collaborative Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1056\/NEJM198209093071104","article-title":"Dietary protein intake and the progressive nature of kidney disease: The role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease","volume":"307","author":"Brenner","year":"1982","journal-title":"N. 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