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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 2  |  Page : 45

Ketoanalogues of aminoacids in chronic kidney disease


Honourary Nephrologist, Lilavati Hospital, Mumbai, Maharashtra, India

Date of Web Publication6-Dec-2018

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-1540.247000

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How to cite this article:
Suratkal L H. Ketoanalogues of aminoacids in chronic kidney disease. J Renal Nutr Metab 2018;4:45

How to cite this URL:
Suratkal L H. Ketoanalogues of aminoacids in chronic kidney disease. J Renal Nutr Metab [serial online] 2018 [cited 2018 Dec 17];4:45. Available from: http://www.jrnm.in/text.asp?2018/4/2/45/247000

Chronic kidney disease (CKD) is reaching endemic proportions like Diabetes and Hypertension. As per the USRDS data the prevalence in the USA is 14.8% of the adult population. As per a recent meta analysis the prevalence in India is 13.1%. Once established the progression is relentless and little can be done to halt the progression. One can attempt to retard the progression to end stage renal disease by strict glycaemic control in diabetics strict BP control especially with the help of renin angiotensin system (RAS) blockers and protein restriction. Protein restriction can be either 0.6 gm/kg with 50% of high biologic value (LPD) or 0.3 gm/kg supplemented with essential amino acids or keto analogues of essential amino acids (sVLPD).

Ketoanalogues lack amino nitrogen. They take endogenous Nitrogen and get converted into essential aminoacids (EAA) in various tissues like Liver, Muscles and Intestines. This leads to effective utilization of nitrogen to form essential amino acids. The benefits are slower progression of CKD, amelioration of symptoms and postponement of dialysis. More important it prevents malnutrition and protein energy wasting (PEW). Besides it leads tobetter blood pressure control, reducesproteinuria, improves insulin sensitivity, improves lipid profile, oxidative and inflammatory status, improves calcium-phosphate metabolism, correction of metabolic acidosis.

The MDRD study was a negative study which caused a setback to ketoanalogues. However later analysis have exposed the limitations of this study. Teplan et al., Garneata et al., Picolli et al. are a few experts to work on ketoanalogues and show the benefits of this intervention. In India Sunil prakash et al. demonstrated with an elegant study the effectiveness of ketoanalogues. We have included in our presentation a few case studies and our own randomized controlled trial in a diabetic population the usefulness of ketoanalogues in retarding progression and improving parathyroid function.




 

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