Public Release: 

Dietary changes may help postpone dialysis in patients with chronic kidney disease

A vegetarian very low-protein diet supplemented with ketoanalogues may slow disease progression

American Society of Nephrology

Highlight

  • Five patients with severely reduced kidney function would need to adhere to a ketoanalogue-supplemented very low-protein diet to avoid a >50% reduction in kidney function or the need for dialysis in 1 patient.

  • Approximately 26 million people in the United States have chronic kidney disease.

Washington, DC (January 28, 2016) -- Adhering to a certain diet may help postpone the need for dialysis in patients with chronic kidney disease (CKD), according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Diet is a critical component in the management of CKD, and different dietary regimens have been proposed over the years. Protein restriction seems to be especially beneficial, leading to reduced sodium intake and better blood pressure control, among other effects. Some studies indicate that adding ketoanalogues, which are nitrogen-free analogues of essential amino acids, can also have favorable effects. In the human body, ketoanalogues capture nitrogen and convert it into amino acids, which are the building blocks of proteins.

Liliana Garneata, MD, PhD (Dr. Carol Davila Teaching Hospital of Nephrology, in Bucharest, Romania) and her colleagues designed a randomized trial to evaluate the effectiveness and safety of a vegetarian very low-protein diet supplemented with ketoanalogues for slowing progression of CKD. For the trial, 207 patients with CKD were randomized to a ketoanalogue-supplemented diet (0.3 g/kg vegetable proteins plus ketoanalogues per day) or continue a mixed low-protein diet (0.6 g/kg per day) for 15 months.

The team found that 5 patients with severely reduced kidney function (stage 4 or higher CKD) would need to adhere to the ketoanalogue-supplemented diet to avoid a >50% reduction in kidney function or the need for dialysis in 1 patient.

The beneficial effects of the ketoanalogue-supplemented vegetarian very-low protein diet seemed to stem from its ability to correct metabolic complications of advanced CKD, rather than its effects on kidney function.

"The results draw attention to the role of dietary interventions, particularly of a ketoanalogue-supplemented vegetarian protein-restricted diet, as effective, safe, and feasible in selected pre-dialysis patients with CKD," said Dr. Garneata. "This type of nutritional intervention could be used in compliant patients with advanced disease and with good nutritional status to postpone dialysis initiation."

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Study co-authors include Alexandra Stancu, MD, Diana Dragomir, MD, Gabriel Stefan, MD, and Gabriel Mircescu, MD, PhD.

Disclosures: Liliana Garneata participated in scientific meetings (as a speaker) and at the international advisory board meetings for Ketosteril; speaker fees and consultancy fees were received from Fresenius Kabi. Alexandra Stancu has no known conflicts of interest. Diana Dragomir has no known conflicts of interest. Gabriel Stefan participated as a speaker in a National scientific meeting; speaker fee was received from Fresenius Kabi. Gabriel Mircescu has no known conflicts of interest.

The article, entitled "Ketoanalogue-Supplemented Vegetarian Very Low-Protein Diet and CKD Progression," will appear online at http://jasn.asnjournals.org/ on January 28, 2016, doi:10.1681/ASN.2015040369.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with nearly 16,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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