The effect of a keto acid supplement on the course of chronic renal failure and nutritional parameters in predialysis patients and patients on regular hemodialysis therapy: the Hungarian Ketosteril Cohort Study.
The results of the Hungarian Ketosteril follow up cohort study are reported. Aim of the study was to evaluate the feasiblity and effects of a low protein diet supplemented with keto acids/amino acids (KA) on the progression of chronic renal failure (CRF) in a large group of predialysis patients (PRE) and on nutritional parameters in both PRE and dialysis patients (DIA).


METHODS
PRE (N = 181) and DIA (N = 42) patients treated in 47 hungarian nephrology and dialysis centres were followed through 18 months. A standardized dietary and KA supplementation protocol was prescribed (PRE group: KA 0.1 g/kgBW/day; dietary protein 0.5-0.6 g/kgBW/day; energy 30 kcal/kgBW/day; DIA group: dietary protein 1.2 g/kgBW/day, KA and energy prescription similar to the PRE group). Progression of CRF was evaluated by linear regression analysis of 1/serum Creatinine (sCr) values versus time, subjective global assessment (SGA) scores were analyzed by Chi-square test, other metabolic parameters (serum albumin, parathormone [iPTH], Ca/P product) were analyzed by descriptive statistics.


RESULTS
In PRE patients slopes of 1/sCr were in the range of 0.0022-0.0015 [100 ml/mg x month], showing no significant difference in the three subgroups of PRE patients (Group A: initial serum creatinine (sCr) 201-400, Group B: sCr 401-600, Group C: sCr > 600 mmol/L). Serum albumin levels below 35 g/L improved significantly, iPTH levels showed a tendency to improve during KA supplementation. In dialysis patients there was an improvement in SGA scores. Midweek predialysis blood urea and sCr levels did not change significantly.


CONCLUSIONS
In a large group of PRE patients prescription of a low protein diet supplemented with KA is feasible and leads to a diminution of 1/sCr equation slopes independent from the degree of renal dysfunction, suggesting a retardation in the rate of CRF progression. There was an improvement in nutritional parameters both in PRE and DIA patients, the latter being characterized by improved SGA scores.
Zakar
G
G
St. Pantaleon Hospital, 2nd Medical Department, Eurocare 13th Dialysis Center, Dunaújváros, Hungary. gzakar.mis@mail.matav.hu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000627:therapeutic use; D000601:Amino Acids, Essential / Q000627:therapeutic use*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D018753:Diet, Protein-Restricted / Q000379:methods*; D019587:Dietary Supplements; D005260:Female; D005526:Food, Formulated; D006801:Humans; D006814:Hungary; D007651:Keto Acids / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000596:Amino Acids; D000601:Amino Acids, Essential; D007651:Keto Acids; C048995:ketosteril; D003404:Creatinine