Efficacy of the Essential Amino Acids and Keto-Analogues on the CKD progression rate in real practice in Russia - city nephrology registry data for outpatient clinic

Abstract

BackgroundRenal replacement therapy (RRT) is growing by 10 % per year in Russia, but pre-dialysis care which can retard CKD progression and delay the start of RRT remains limited. We evaluate the effect of Essential Amino Acids and Keto-analogues (EAA/KA) on CKD progression.MethodsThe effect of low protein diet (LPD), supplemented by EAA/KA, on GFR slope changes between first and second treatment period (five sequential visits per period) in 96 patients withs CKD Stage 3B-5 was compared to GFR slope changes in the control group of 96 patients, randomly selected from matched (by gender, age, diagnosis and CKD Stage) cohort of 320 patients from the city Registry. The mean baseline eGFR was 23 ± 9 ml/min/1.73 m2; 29 % had CKD3B, 45 % - CKD4, 26 % - CKD5.ResultsThe rate of eGFR decline changed from −2.71 ± 2.38 to −2.01 ± 2.26 ml/min/1.73 m2 per year in the treatment group and from −2.18 ± 2.01 to −2.04 ± 2.18 ml/min/1.73 m2 per year in the control group. Only in the treatment group the difference was significant (p = 0.04 and p = 0.6). Standardized effect size for intervention was significant in treatment group: −0.3 (of pooled SD), 95 % CI −0.58 ÷ −0.02 and non-significant in control group: −0.07 (−0.35 ÷ +0.22). The univariate and multivariate analysis of EAA/KA therapy effect demonstrated that it was probably more effective in patients of older age, with higher time-averaged proteinuria (PU), lower phosphate level, in patients with glomerular v. interstitial diseases, and in females. Only the latter factor was significant at pre-specified level (<0.05).ConclusionsLPD combined with EAA/KA supplementation lead to the decrease of the CKD progression both in well-designed clinical study and in real nephrology practice in wide variety diseases and settings. Registry data can be helpful to reveal patients with optimal chances for beneficial effect of LPD supplemented by EAA/KA.Trial registrationISRCTN28190556 06/05/2016.

Uremic Sarcopenia and Its Possible Nutritional Approach

“…A subsequent study by Zemchenkov et al of 96 CKD patients with stage 3b-5 confirmed that an LPD supplemented with essential amino acids and KAs induced a slowdown in the progression of CKD, particularly in female elderly patients and in those with low levels of plasma phosphorus [ 132 ].…”

Nutritional treatment of advanced CKD: twenty consensus statements

“…In the ‘80s and ‘90s, Giovannetti and Locatelli began the Integrated Dialysis Dietary Program (IDDP) in patients with GFR < 3 ml/min/1.73 m 2 , consisting of a weekly hemodialysis session integrated with a very low protein diet equal to 0.3–0.4 g/kg/day (VLPD) supplemented by essential amino acids and their ketoanalogues [ 101 , 102 ]. Even then, the perception that DNT was an important therapeutic tool for delaying the start of dialysis was established [ 103 – 105 ]. Numerous other reports demonstrate that duration and/or frequency of dialysis produces pro-inflammatory and pro-oxidative cytokine stress which leads a reduction in RRF [ 106 ].…”

Very low protein diet plus ketoacid analogs of essential amino acids supplement to retard chronic kidney disease progression

“…Recently, a well-defined, randomized, controlled trial demonstrated that vegetarian VLPD supplemented with ketoacid analogs delayed dialysis initiation among patients with advanced CKD with GFR less than 20 to 30 mL/min/1.73 m 2 by ameliorating metabolic disturbances [22]. Finally, recent meta-analyses and real clinical practice in nephrology registry supported that VLPD or LPD, supplemented with ketoacid analogs, significantly prevented the deterioration of GFR [10,23,24]. Related clinical trials were investigated among patients with very late stages of CKD or CKD stage V, who wished to defer dialysis treatment.…”