Ketoacid Supplementation Partially Improves Metabolic Parameters in Patients on Peritoneal Dialysis

Abstract

♦ Background: A low protein diet supplemented with ketoacids has been shown to improve the metabolic profile, including insulin resistance, in patients with chronic kidney disease (CKD), but whether ketoacids alone exert similar effects is unknown. In this prospective randomized controlled trial, we aimed to evaluate the effects of ketoacid supplementation on insulin resistance, systemic inflammation, oxidative stress and endothelial dysfunction among 100 CKD patients undergoing peritoneal dialysis (PD). ♦ Methods: Patients from one Chinese PD center were randomly assigned to take ketoacids (12 tablets per day) (n = 50) versus a control group (n = 50) for 6 months in an open-label parallelarm design. Daily protein intake of 0.8 -1.2 g/kg/d and daily energy intake of 25 -35 kcal/kg/d was prescribed to both groups. Insulin resistance was evaluated using homeostatic model assessment (HOMA-IR) index as the primary outcome. We assessed systemic inflammation using high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6), oxidative stress using plasma oxidized low density lipoprotein (oxLDL), adipokines using leptin and adiponectin and endothelial dysfunction using serum soluble intercellular adhesion molecule-1 (sICAM) and soluble vascular adhesion molecule-1 (sVCAM) as secondary outcomes. ♦ Results: There were no significant differences in baseline characteristics between the 2 groups except a slightly higher age in patients assigned to the intervention. A total of 89% of participants completed the 6-month intervention. There was no significant difference in the change of HOMA-IR values from baseline between groups after adjusting for baseline age, gender, body mass index and HOMA-IR. For secondary outcomes, hs-CRP varied significantly between groups (p = 0.02), increasing over time for the control group while remaining stable for the ketoacid group. Similarly, the leptin/adiponectin ratio (LAR) differed between groups (p < 0.001), remaining stable in the ketoacid group but increasing in the control group. ♦ Conclusion: Ketoacid therapy administered for 6 months had no effect on HOMA-IR but resulted in improvements in hs-CRP and LAR, suggesting metabolic benefit. Future studies are needed to confirm these results and any potential benefit in vascular health of PD patients.

[Retracted] WeChat‐Based Comprehensive Education on Egg White Protein Intake for Patients Undergoing Peritoneal Dialysis: A Combined Prospective and Retrospective Study

“…e target DPI of ≥0.8 g/kg, of which at least 50% would be of a high biological value, is the basic recommendation. Chinese PD patients find it challenging to achieve the KDIGO target of 1.2-1.4 g/kg of DPI [25]. In addition to the basic food-derived DPI, all patients received α-ketoacidosis supplements at a dose of 5 g/day and are instructed to take 2-4 egg whites per day along with their usual diet.…”

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

“…In the pre-dialysis phase, plant based, low, or very low protein diets supplemented with a mixture of essential amino acids and ketoacids are generally associated with a slower progression of chronic kidney disease (CKD), and some data on the chronic use of these supplements in dialysis patients are promising with respect to the preservation of residual kidney function and urine volume output [122][123][124][125]. We therefore consider the use of this formulation in dialysis patients with low protein intake and low albumin levels and who prefer "pills" to other oral supplements.…”

Adherence to ketoacids/essential amino acids-supplemented low protein diets and new indications for patients with chronic kidney disease

“…This hypothesis, already suggested by Hiroshige et al [ 23 ] who used branched-chain amino acids, has not yet been addressed by adequate clinical trials using KA/EAA and therefore should be a subject for future research. Preliminary data from a recent Chinese randomized trial in 100 chronic peritoneal dialysis patients, those patients who received KA/EAA supplements displayed reduced inflammatory status and a decreased serum leptin/adiponectin ratio as compared with the control group [ 24 ]. In addition, reducing protein intake with the addition of KA/EAA supplements, under strict dietary and nutritional assessments may help controlling serum phosphate in countries where limited phosphate binders are available [ 25 , 26 ].…”