Effects of Severe Protein Restriction with Ketoanalogues in Advanced Renal Failure

Abstract

Objective: To compare a severe protein restriction diet supplemented with ketoanalogues to a moderate protein restriction diet in order to limit glomerular filtration rate (GFR) decrease in an advanced renal insufficiency stage.

Design: Prospective randomised study conducted to compare a severe protein restriction diet (0.30 g/kg/day) supplemented with a preparation of ketoanalogues, hydroxyanalogues of aminoacids and aminoacids (Group A) to a moderate protein restriction diet (0.65 g/kg/day) (Group B).

Patients: 50 uremic patients included (25 in each group) with GFR is <20 mL/min/1.73m².

Results: There were no statistically significant differences between the two dietary regimens for the renal survival. But uremia decreased significantly in Group A (22.7±5.2 to 18.5±6.7 mmol/L) and increased in Group B (26.8±9.0 to 34.9±9.9 mmol/L). Calcemia increased in Group A from 2.28±0.18 to 2.42±0.17 mmol/L, p<0.01 with a stable phosphoremia while calcemia decreased in Group B (2.33±0.18 to 2.25±0.17 mmol/L, p<0.05). At the end of the study, Group A was different from Group B for calcemia (2.42±0.17 vs. 2.25±0.17 mmol/L, p<0.01), phosphoremia (1.39±0.30 vs. 1.80±0.65 mmol/L, p<0.02), alkaline phosphatase (61.42±22.93 vs. 78.8±27.0, p<0.05) and parathormone plasma levels (2.71±1.55 vs. 5.91±1.41 ng/mL, p<0.001).

Comments: Compared to a moderate protein restriction (0.65 g/kg/day), a severe protein restriction (0.3 g/kg/day) supplemented by ketoanologues does not limit GFR decrease when GFR is below 20 mL/min/1.73m², but improves phosphocalcic plasma parameters.

• uremia
• protein restriction
• renal failure
• ketoanalogues