Treatment of chronic kidney disease patients with ketoanalogue-supplemented low-protein diet and ketoanalogue-supplemented very-low-protein diet

Summary Introduction A low-protein diet supplemented with ketoanalogues (KAs) has been shown to be effective in improving the benefits of a low-protein diet for patients with chronic kidney disease (CKD). Materials and methods A total of 178 adult patients with CKD Stages 3–5 (predialysis) were assessed for 1 year. A total of 122 patients were in the KA-supplemented low-protein diet (sLPD) group and were prescribed 0.6 g/kg body weight (BW) of dietary proteins supplemented with one KA tablet for every 10 kg BW. The remaining 56 patients were in the KA-supplemented very-low-protein diet (sVLPD) group and received 0.3 g/kg BW of dietary protein supplemented with one KA tablet for every 5 kg BW. Renal, metabolic, and nutritional parameters, and anthropometric assessments were performed for all patients. Results We assessed the renal function of the patients. There was no difference in the baseline clinical and laboratory characteristics between the sLPD and sVLPD groups. In the sLPD group, the blood urea level decreased from 85.38 ± 4.45 to 76.90 ± 42.90 mg/dL ( p p p  > 0.05) at the end of 1 year. The CrCl showed a marginal increase at the end of 1 year, but this increase was not statistically significant. There was a decrease in urinary protein excretion in both groups. Anthropometric measurement, including Subjective Global Assessment, showed nutritional improvement in both groups. Pearson correlation coefficient between protein intake and urinary nitrogen appearance showed positive correlation between the two groups. Conclusion The CKD patients on sLPD and sVLPD showed improvement in renal function, metabolic status, and nutrition. 方法 研究對象為 178 位 3–5 期(透析前)慢性腎病成年患者，其中 122 人接受酮類似物 (KA) 補充之低蛋白飲食 (sLPD)—含每公斤體重 0.6 g 蛋白質及每 10 公斤體重 1 顆 KA 錠；另 56 人接受 KA 補充之極低蛋白飲食 (sVLPD)—含每公斤體重 0.3 g 蛋白質及每 5 公斤體重 1 顆 KA 錠。治療期間的測量項目包括腎功能、代謝、營養學、體格等方面的變化。 結果 在各項基線臨床及化驗特徵上，sLPD 及 sVLPD 兩組之間無明顯差異。經過 12 個月後，sLPD 組的血中尿素從 85.38 ± 4.45 mg/dl 下降至 76.90 ± 42.90 mg/dl ( p p p  > 0.05)，12 個月的 CCT 則呈現增加的傾向。在兩組的病人間，尿液蛋白排泄量均明顯下降，體格方面的測量包括 SGA 均呈現營養狀況的改善。兩組間，以 Pearson's 系數分析可見，蛋白質攝取量與尿液氮出現量呈現明顯的相關性。 結論 慢性腎病患者在接受 sLPD 及 sVLPD 期間，腎功能、代謝及營養狀況均呈現出穩定化的情形。