title: Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients?
abstract: Early versus later start of dialysis is still a matter of debate. Low-protein diets have been used for many decades to delay dialysis initiation. Protein-restricted diets (0.3-0.6 g protein/kg/day) supplemented with essential amino acids and ketoanalogues (sVLPD) can be offered, in association with pharmacological treatment, to motivated stage 4-5 chronic kidney disease (CKD) patients not having severe comorbid conditions; they probably represent 30-40% of the concerned population. A satisfactory adherence to such dietary prescription is observed in approximately 50% of the patients. While the results of the studies on the effects of this diet on the rate of progression of renal failure remain inconclusive, they are highly significant when initiation of dialysis is the primary outcome. The correction of uremic symptoms allows for initiation of dialysis treatment at a level of residual renal function lower than that usually recommended. Most of the CKD-associated complications of cardiovascular and metabolic origin, which hamper both lifespan and quality of life, are positively influenced by the diet. Lastly, with regular monitoring jointly assumed by physicians and dietitians, nutritional status is well preserved as confirmed by a very low mortality rate and by the absence of detrimental effect on the long-term outcome of patients once renal replacement therapy is initiated. On account of its feasibility, efficacy and safety, sVLPD deserves a place in the management of selected patients to safely delay the time needed for dialysis.
authors.affiliation: Nephrology Department, Hopital Pellegrin et Université Bordeaux II, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Aparicio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bellizzi
authors.forename: Philippe
authors.initials: P
authors.lastname: Chauveau
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
authors.forename: Tevfik
authors.initials: T
authors.lastname: Ecder
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.forename: Liliana
authors.initials: L
authors.lastname: Garneata
authors.forename: Shanyan
authors.initials: S
authors.lastname: Lin
authors.forename: William
authors.initials: W
authors.lastname: Mitch
authors.forename: Vladimir
authors.initials: V
authors.lastname: Teplan
authors.forename: Xueqing
authors.initials: X
authors.lastname: Yu
authors.forename: Gabor
authors.initials: G
authors.lastname: Zakar
mesh_terms: D000601:Amino Acids, Essential / Q000627:therapeutic use*; D018753:Diet, Protein-Restricted; D019587:Dietary Supplements; D006801:Humans; D018579:Patient Selection; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment
chemical_list: D000601:Amino Acids, Essential