title: Efficacy of the Essential Amino Acids and Keto-Analogues on the CKD progression rate in real practice in Russia - city nephrology registry data for outpatient clinic.
abstract: Renal replacement therapy (RRT) is growing by 10 % per year in Russia, but pre-dialysis care which can retard CKD progression and delay the start of RRT remains limited. We evaluate the effect of Essential Amino Acids and Keto-analogues (EAA/KA) on CKD progression.
  
  
  
  The effect of low protein diet (LPD), supplemented by EAA/KA, on GFR slope changes between first and second treatment period (five sequential visits per period) in 96 patients withs CKD Stage 3B-5 was compared to GFR slope changes in the control group of 96 patients, randomly selected from matched (by gender, age, diagnosis and CKD Stage) cohort of 320 patients from the city Registry. The mean baseline eGFR was 23 ± 9 ml/min/1.73 m2; 29 % had CKD3B, 45 % - CKD4, 26 % - CKD5.
  
  
  
  The rate of eGFR decline changed from -2.71 ± 2.38 to -2.01 ± 2.26 ml/min/1.73 m2 per year in the treatment group and from -2.18 ± 2.01 to -2.04 ± 2.18 ml/min/1.73 m2 per year in the control group. Only in the treatment group the difference was significant (p = 0.04 and p = 0.6). Standardized effect size for intervention was significant in treatment group: -0.3 (of pooled SD), 95 % CI -0.58 ÷  -0.02 and non-significant in control group: -0.07 (-0.35 ÷ +0.22). The univariate and multivariate analysis of EAA/KA therapy effect demonstrated that it was probably more effective in patients of older age, with higher time-averaged proteinuria (PU), lower phosphate level, in patients with glomerular v. interstitial diseases, and in females. Only the latter factor was significant at pre-specified level (<0.05).
  
  
  
  LPD combined with EAA/KA supplementation lead to the decrease of the CKD progression both in well-designed clinical study and in real nephrology practice in wide variety diseases and settings. Registry data can be helpful to reveal patients with optimal chances for beneficial effect of LPD supplemented by EAA/KA.
  
  
  
  ISRCTN28190556 06/05/2016.
authors.affiliation: City Mariinsky Hospital - City Nephrology Center, Liteiny pr., 56, 191104, Saint Petersburg, Russian Federation. kletk@inbox.ru.|North-Western State Medical University n.a. I.I. Mechnikov, Internal Diseases and Nephrology Chair, Kirochnaya str., 41, 191015, Saint Petersburg, Russian Federation. kletk@inbox.ru.|First St.-Petersburg State Medical University n.a. I.P.Pavlov, Nephrology and Dialysis Chair, L'va Tolstogo str., 6-8, 197022, Saint Petersburg, Russian Federation. kletk@inbox.ru.
authors.forename: Alexander
authors.identifier: 0000-0002-4590-3380
authors.initials: A
authors.lastname: Zemchenkov
authors.affiliation: City Mariinsky Hospital - City Nephrology Center, Liteiny pr., 56, 191104, Saint Petersburg, Russian Federation. inkonakova@yandex.ru.|North-Western State Medical University n.a. I.I. Mechnikov, Internal Diseases and Nephrology Chair, Kirochnaya str., 41, 191015, Saint Petersburg, Russian Federation. inkonakova@yandex.ru.
authors.forename: Irina N
authors.initials: IN
authors.lastname: Konakova
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities; D000596:Amino Acids / Q000627:therapeutic use*; D016022:Case-Control Studies; D002947:Cities; D018753:Diet, Protein-Restricted; D019587:Dietary Supplements; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007651:Keto Acids / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology* / Q000628:therapy*; D017582:Renal Replacement Therapy; D012426:Russia; D012737:Sex Factors
chemical_list: D000596:Amino Acids; D007651:Keto Acids
keywords: CKD progression; Essential Amino Acids and Keto-Analogues; Low protein diet; Supplemented low protein diet; eGFR slope