[Analysis of the Effectiveness of Renoprotection of Low-Protein Diet and Ketoanalogues of Amino Acids In Patients With Chronic Kidney Disease].
Study Goal
The researchers aimed to compare the effectiveness of a low-protein diet (LPD) with ketoanalogues of amino acids (KA/AA) versus traditional LPD without KA/AA in slowing kidney function decline and improving metabolic parameters in CKD patients.
Results Summary
The study found that LPD with KA/AA significantly slowed the decline in GFR, reduced proteinuria, improved lipid metabolism, and maintained hemoglobin levels compared to traditional LPD or no intervention. Patients on LPD with KA/AA also achieved better blood pressure control and fewer required renal replacement therapy.
Population
63 patients with CKD stages 3-4, primarily with glomerulonephritis, and 30 healthy controls.
Effective Dosage
Not specified
Duration
Up to 72.1 months
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
low-protein diet with prescription of ketoanalogues of amino acids (KA/AA) | decrease | rate of decline in glomerular filtration rate (GFR) | patients with CKD stages 3-4 | -0.78 mL/min/year vs -4.9 ml/min/year | significantly lower | #1 |
low-protein diet with prescription of ketoanalogues of amino acids (KA/AA) | decrease | need for renal replacement therapy | patients with CKD stages 3-4 | 9.7% | needed the start of renal replacement therapy | #2 |
traditional low-protein diet without ketoanalogues | decrease | need for renal replacement therapy | patients with CKD stages 3-4 | 18.1% | needed the start of renal replacement therapy | #3 |
natural course of CKD | decrease | need for renal replacement therapy | patients with CKD stages 3-4 | 40% | needed the start of renal replacement therapy | #4 |
renoprotective therapy, including low-protein diet with KA/AA | decrease | blood pressure | patients with CKD stages 3-4 | < 140/90 mm Hg | reached target levels | #5 |
low-protein diet with KA/AA | decrease | proteinuria | patients with CKD stages 3-4 | - | significant reduction | #6 |
low-protein diet with KA/AA | increase | lipid metabolism | patients with CKD stages 3-4 | - | improvement | #7 |
low-protein diet with KA/AA | no change | hemoglobin levels (Hb) | patients with CKD stages 3-4 | - | prevent of reduction | #8 |
low-protein diet with KA/AA | no change | metabolic disorders of protein and calcium-phosphate metabolism | patients with CKD stages 3-4 | - | prevent of development | #9 |
traditional low-protein diet without KA/AA | decrease | blood pressure | patients with CKD stages 3-4 | - | fewer reductions | #10 |
traditional low-protein diet without KA/AA | no change | diastolic blood pressure (DBP) | patients with CKD stages 3-4 | - | did not change | #11 |
traditional low-protein diet without KA/AA | decrease | proteinuria | patients with CKD stages 3-4 | - | less significant reduction | #12 |
traditional low-protein diet without KA/AA | no change | protein and calcium-phosphate metabolism | patients with CKD stages 3-4 | - | no negative dynamics | #13 |
traditional low-protein diet without KA/AA | increase | levels of total cholesterol and LHD | patients with CKD stages 3-4 | - | significantly increased | #14 |
no renoprotection recommendations | decrease | studied parameters | patients with CKD stages 3-4 | - | demonstrated negative dynamics | #15 |
AIM: Analysis of the effectiveness of renoprotection in patients with chronic kidney disease (CKD), who is observed by general practitioners for up to 72.1 months, keeping traditional LPD or LPD with prescription of ketoanalogues of amino acids (KA/AK). METHODS: 63 patients with CKD stages 3-4, mainly with glomerulonephritis (GN), were divided into 3 groups: 1 gr--31 patients (53.3 ± 3.1 years old; M/F--18/13), LPD with prescription of ketoanalogues of amino acids; 2 gr--22 patients (54.9 3.2 years old; M/F--13/9) traditional LPD without ketoanalogues; 3 gr--10 patients (51.7 ± 4.2 years old; M/F--6/4) with natural course of CKD. Group 4 (control)--30 healthy subjects (52.3 ± 2.2 years old; M/F--16/14). The following parameters were studied: dynamics of the glomerular filtration rate (GFR), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin levels (Hb), daily proteinuria, and basic parameters of protein, lipid and phosphate- calcium metabolism. RESULTS: The rate of decline in GFR was significantly lower in patients of the first group (-0.78 mL/min/year) than those of the second group (-4.9 ml/min/year). 9.7% of patients of the first group needed the start of renal replacement therapy at the end of the observation, 18.1%--of the second group and 40%--of the third. All patients who received renoprotective therapy, including low-protein diet with KA/AA reached target levels of blood pressure < 140/90 mm Hg. Patients of this group was able to achieve a significant reduction in proteinuria, improvement of lipid metabolism, prevent of reduction of Hb and the development of metabolic disorders of protein and calcium-phosphate metabolism. The second group of patients, following nephroprotection recommendations and LPD without KA/AA, had fewer reductions in BP without reaching the target level, DBP did not change; reduction of proteinuria was less significant than in group 1. There was no negative dynamics of protein and calcium-phosphate metabolism, though significantly increased levels of total cholesterol and LHD were observed. The third group of patients, who did not follow the renoprotection recommendations demonstrated negative dynamics of the studied parameters. CONCLUSION: Renoprotection based on the use KA/AA in patients with CKD stages 3-4 proved to be more effective than without it in slowing the rate of decline in GFR, hypertension correction, proteinuria reduction, maintaining the level of Hb, prevention of disorders of protein and calcium-phosphate metabolism, as well as correction of the lipid metabolism.