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Abstract: SA-PO796

Decline in Renal Function After Withdrawing Ketoanalogue Supplementation: A Randomized Clinical Trial

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Author

  • Saxena, Anita, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Group or Team Name

  • SGPGI Group
Background


Studies have reported preservation of renal function and nutritional status in patients with a low protein diet supplemented by ketoanalogues.
Our group reported preservation of renal function and nutritional status in patients who were supplemented with ketoanalogues . The aim of the study was to evaluate if the renal function is maintained after withdrawing ketoanalogue supplementation despite continuing on the same diet.

Methods


Forty CKD patients were randomized into two groups: Group 1 (Intervention) patients were supplemented with 6 tablets of ketoanalogue for 10 months. Patients were advised very low protein diet 0.4 g/kg/day.
Group 2 (Control) patients were given conservative treatment with 0.6 g/kg/d protein restriction. Dietary assessment was done at visit 1 and at visit 2 (10 months). Nutritional assessment was evaluated with SGA score. GFR and serum albumin were evaluated at baseline and at 10 months. After 10 months ketoanalogue supplementation was stopped and patients were followed up for four years with same dietary intake.

Results

At baseline, the GFR was higher in controls (51.14±15.1 ml/minute). compared to supplemented group (47.79±13.2 ml/minute). After 10 months in control group, in GFR decline by 15.54 ml/min (51.14 to 35.5±7.94 ml/minute) and serum albumin decreased from 3.8±0.90 g/dL to 3.09±0.38 g d/l. In supplemented group the GFR and albumin remained stable at 47.79±13.2 ml/minute and 4.11±0.43 respectively . In ketoanalogue group patients did not comply to low protein diet, in stead they consumed normal protein diet 0.62±0.24 g/kg/d. In supplemented group serum creatinine decreased from 1.61±0.52 to 1.40±0.52 but increased to 2.2 mg% after stopping ketoanalgue. After stopping supplementation at 10 months patients were followed up for four years. Gradual decline was observed in GFR (47.79±13.2 to 28.0 ml/minute) and albumin (4.11±0.43 to 3.6 g/dL) . Some patients progressed to ESRD. After stopping ketoanalogues, the dietary intake remained the same

Conclusion

Low protein diet supplemented with ketoanalogues preserves renal function and nutritional status in predialysis patients. However, a rapid decline in renal function is observed after stopping ketoanalogue supplemention.


Funding

  • Commercial Support