title: Reduction of morbidity related to emergency access to dialysis with very low protein diet supplemented with ketoacids (VLPD+KA).
abstract: OBJECTIVE
  To delay the beginning of the renal replacement therapy (RRT) until the AV fistula is either made and mature or the training for peritoneal dialysis (PD) is given.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Nephrology's Ambulatory, Hospital Servidor Público Estadual.
  
  
  METHODS
  21 patients with chronic kidney disease (CKD) have been followed.
  
  
  METHODS
  For a period of 30 days, a VLPD+KA would be prescribed until the AV fistula was made or the PD training was given The patients were evaluated prior to the beginning of the VLPD+KA, on the 15th and the 30th day, and at the end of the study, with physical and nutritional evaluation, laboratory tests and 24-hour excretion of urinary urea and urinary protein, creatinine and urea residual clearance.
  
  
  RESULTS
  47.6% (10/21) of the patients have initiated HD with matured and suitable AV fistula made in 30 days; 33.3% (7/21) of the patients have been unfit to initiate RRT, even though with sufficient time for the creation of the AV fistula or the training for PD due to AV fistula thrombosis; 14.3% (3/21) of the patients have remained in the study with no need for dialysis, and 4.8% (1/21) have been excluded on the grounds of not having adhered to the VLPD+KA. The anthropometric parameters and the energy intake have not differed from one period to the other.
  
  
  CONCLUSIONS
  The VLPD+KA is safe to maintain the nutritional status of patients of CKD until the AV fistula is made or the PD training is given.
authors.affiliation: Nephrology Division, Hospital do Servidor Público Estadual, São Paulo, Brazil. martaduenhas@uol.com.br
authors.forename: Marta
authors.initials: M
authors.lastname: Duenhas
authors.forename: Elsa
authors.initials: E
authors.lastname: Gonçalves
authors.forename: Mônica
authors.initials: M
authors.lastname: Dias
authors.forename: Graziela
authors.initials: G
authors.lastname: Leme
authors.forename: Sandra
authors.initials: S
authors.lastname: Laranja
mesh_terms: D000328:Adult; D000368:Aged; D018753:Diet, Protein-Restricted; D004630:Emergencies; D002149:Energy Intake; D005260:Female; D006801:Humans; D007651:Keto Acids / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D006435:Renal Dialysis
chemical_list: D007651:Keto Acids