The effect of energy restriction on development and progression of chronic kidney disease: review of the current evidence.

Afsar B. , Afsar R. E. , Copur S., Sag A. A. , Ortiz A., Kanbay M.

The British journal of nutrition, vol.125, pp.1201-1214, 2021 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 125
  • Publication Date: 2021
  • Doi Number: 10.1017/s000711452000358x
  • Title of Journal : The British journal of nutrition
  • Page Numbers: pp.1201-1214
  • Keywords: Energy restriction, Chronic kidney disease, Energy restriction mimetics, Autophagy, Mammalian target of rapamycin pathway, TERM CALORIE RESTRICTION, ISCHEMIA-REPERFUSION INJURY, DIETARY RESTRICTION, OXIDATIVE STRESS, RENAL-DISEASE, CARBOHYDRATE RESTRICTION, DIABETIC-NEPHROPATHY, WEIGHT-LOSS, PROTEIN, EXPRESSION

Abstract

Energy restriction (ER) has anti-ageing effects and probably protects from a range of chronic diseases including cancer, diabetes and chronic kidney disease (CKD). Specifically, ER has a positive impact on experimental kidney ageing, CKD (diabetic nephropathy, polycystic kidney disease) and acute kidney injury (nephrotoxic, ischaemia-reperfusion injury) through such mechanisms as increased autophagy, mitochondrial biogenesis and DNA repair, and decreased inflammation and oxidative stress. Key molecules contributing to ER-mediated kidney protection include adenosine monophosphate-activated protein kinase, sirtuin-1 and PPAR-gamma coactivator 1 alpha. However, CKD is a complex condition, and ER may potentially worsen CKD complications such as protein-energy wasting, bone-mineral disorders and impaired wound healing. ER mimetics are drugs, such as metformin and Na-glucose co-transporter-2 which mimic the action of ER. This review aims to provide comprehensive data regarding the effect of ER on CKD progression and outcomes.