A COMPARISON OF PROGRESSION OF CHRONIC RENAL FAILURE: LOW DOSE VS STANDARD DOSE KETOACIDS

Purpose: It has been documented that a low protein diet (LPD) with ketoacid analogues (one ketosteril® /5kg) can postpone dialysis therapy in chronic kidney disease. The purpose of the study was to compare the effects of residual renal function preservation between low dose (one ketosteril® /10kg) and standard dose (one ketosteril® /5kg) ketoacid analogues.Methods: The study was a prospective, open-label, group-comparison design. The duration was 6 months. Patients were enrolled in two hospitals when the serum Cr more than 6 mg/dL (CKD stage 4,5). Then the enrolled patients were randomized to three groups, LPD, LPDK1 (LPD + standard dose ketosteril®), LPDK2 (LPD + low dose ketosteril®). The definition of LPD was 0.6-0.8gm of protein/kg body weight/day. The comparable variables were routine hemogram, bio-chemistry data, iPTH, reciprocal Cr (1/Cr), (eGFR), UN/Cr levels in 24-hr urine (UUN/UCr). The measurements were performed in baseline and 6th month.Results: Demographics of patients were LPD: 22 (M/F:10/12), 49.5y/o, BMI 21.5±3.3; LPDK1:21 (8/13), 53.6y/o, BMI 22.7±3.5; LPDK2:37 (15/22), 62y/o (p:<0.0001), BMI 25.8±4.7 (p:0.001). The significant variables in the baseline between groups as follows: BUN 76.2±26.9, 70.6±17.6, 94.0±25.7mg/dL (p:0.001); Cr 8.8±2.8, 8.0±1.4, 8.7±2.5 mg/dL (NS); K 4.4±0.8, 4.7±0.7 4.9±0.8mEq/L (p:0.047), albumin 4.6±0.4, 4.5±0.3, 4.0±0.4gm/dL (p:<0.001). The levels of 1/Cr from baseline to the 6th month in LPD, LPDK1, LPDK2 demonstrated a significant decline: 0.13→0.11, slope −0.0032; 0.13→0.11, slope -0.003; 0.13→0.12, slope −0.002. However, levels of UUN/UCr and eGFR did not reveal significant changes. UUN/UCr: 5.76→5.88, slope 0.0195, 6.45→6.21, slope −0.0397, 6.27→6.57, slope 0.05. eGFR: 6.16→5.77, slope −0.065; 6.19→5.35, slope −0.12; 5.73→5.41, slope −0.053.Conclusions: The 6-month observation study showed low dose ketoacid analogues combined with LPD had a beneficial effect to slow down renal function deterioration in CKD stage 4,5. However, the slope of 1/Cr levels in low dose ketoacid analogues was less than that in standard dose ketoacid analogues