Ketoanalogues supplementation decreases dialysis and mortality risk in patients with anemic advanced chronic kidney disease

Abstract

BackgroundThe benefit of alpha-Ketoanalogues (KA) supplementation for chronic kidney disease (CKD) patients that followed low-protein diet (LPD) remains undetermined.MethodsWe extracted longitudinal data for all CKD patients in the Taiwan National Health Insurance from January 1, 2000 through December 31, 2010. A total of 1483 patients with anemic advanced CKD treated with LPD, who started KA supplementation, were enrolled in this study. We analyzed the risks of end stage renal disease and all-cause mortality using Cox proportional hazard models with influential drugs as time-dependent variables.ResultsA total of 1113 events of initiating long-term dialysis and 1228 events of the composite outcome of long-term dialysis or death occurred in patients with advanced CKD after a mean follow-up of 1.57 years. Data analysis suggests KA supplementation is associated with a lower risk for long-term dialysis and the composite outcome when daily dosage is more than 5.5 tablets. The beneficial effect was consistent in subgroup analysis, independent of age, sex, and comorbidities.ConclusionsAmong advanced CKD patients that followed LPD, KA supplementation at an appropriate dosage may substantially reduce the risk of initiating long-term dialysis or of developing the composite outcome. KA supplementation represents an additional therapeutic strategy to slow the progression of CKD.

Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study

“…Much evidence has been reported showing that LPDs and vLPDs supplemented with ketoanalogues can help retard CKD progression [ 16 , 20 ] and postpone dialysis [ 23 , 39 ], including one study [ 40 ] that utilized the same database as the current research. However, the evidence of a possible long-term survival benefit of this diet therapy is limited and conflicting.…”

Long-Term Effects of Ketoanalogues on Mortality and Renal Outcomes in Advanced Chronic Kidney Disease Patients Receiving a Low-Protein Diet

“…Studies have demonstrated that the benefits of ketoanalogues (KA) supplementation on mortality and renal outcomes in CKD patients undergoing dietary protein restriction are controversial [7][8][9][10][11]. First, regarding the effects of KA supplementation through a VLPD on patients with stage 4 and 5 CKD, Garneata et al conducted a prospective randomized controlled trial in 207 patients with estimated glomerular filtration rate (eGFR) < 30 mL/min and noted that KA supplementation with a vegetarian VLPD (0.3 g/kg body weight/day) could defer dialysis initiation compared with an LPD (0.6 g/kg body weight/day) alone [7].…”

Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis?

“…Through this process, both sVLPDs (0.3-0.4 g/kg body weight per day) [6] and low-protein diets supplemented with ketoanalogues (sLPDs) (0.6 g/kg body weight per day) [7] can dampen the consequences of protein metabolism, such as the accumulation of nitrogen waste products, metabolic acidosis, and hyperphosphatemia, while maintaining the protein-energy balance. Indeed, several randomized controlled trials (RCTs) [8,9] and observational studies [10,11] have proved that sVLPDs and sLPDs can delay the initiation of dialysis and slightly retard the decline of renal function. Moreover, in those who can adhere to the treatment and frequent follow-up of nutritional status, dietary therapy has been shown not to result in adverse effects during treatment [12,13] or after dialysis initiation [10,14].…”