title: Influence of ketoanalogs supplementation on the progression in chronic kidney disease patients who had training on low-protein diet.
abstract: OBJECTIVE
  A low-protein diet (LPD) is a conservative treatment in patients with chronic kidney disease (CKD) to improve uremic symptoms and slow the progression of renal dysfunction. However, the deleterious effects of protein restriction on nutritional status have raised concern. We investigated whether ketoanalogs supplementation in CKD patients who had training on LPD retards the progression of CKD and maintains nutritional status.
  
  
  METHODS
  Data were collected retrospectively from 120 consecutive patients in the CKD stages III and IV. Firstly all patients were restricted to LPD alone for 6 months (LPD alone), and then ketoanalogs of essential amino acids (KA) were supplemented for 6 months.
  
  
  RESULTS
  The adequate LPD had not achieved in both periods. The declining slopes of glomerular filtration rate (GFR) during the LPD + KA period were significantly lower than those during the LPD alone period. This improvement in GFR was apparent in both subjects with diabetics and non-diabetic patients. Mean serum total cholesterol levels decreased in LPD + KA compared with LPD alone period. However, serum albumin levels did not change. Responders showed a higher prevalence of diabetes and higher serum albumin levels during the LPD alone period. Multivariate analysis revealed that responsiveness to LPD + KA was independently related to diabetes (p = 0.006) and high serum albumin levels (p = 0.011) in the LPD alone period.
  
  
  CONCLUSIONS
  KA supplementation on over LPD delayed the progression of CKD without deteriorating nutritional status, and initial serum albumin levels could be an independent factor.
authors.affiliation: Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Chang
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Ea Wha
authors.initials: EW
authors.lastname: Kang
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Kim
authors.forename: Kyu Hun
authors.initials: KH
authors.lastname: Choi
authors.forename: Ho Yung
authors.initials: HY
authors.lastname: Lee
authors.forename: Dae-Suk
authors.initials: DS
authors.lastname: Han
authors.forename: Sug Kyun
authors.initials: SK
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000601:Amino Acids, Essential / Q000008:administration & dosage*; D002908:Chronic Disease; D018753:Diet, Protein-Restricted; D019587:Dietary Supplements; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged
chemical_list: D000601:Amino Acids, Essential; C048995:ketosteril