Implications of low-protein diet and ketoanalogues of essential amino acids' supplementation for cardiovascular and renal protection in patients with chronic kidney disease


O.N. Kotenko, K.A. Evstigneeva

Low-protein diet (LPD) has been used for decades to reduce uremic symptoms and postpone renal replacement therapy (RRT). LPD with protein restriction (0.6–0.3 g/kg per day) and supplementation with ketoanalogues of essential amino acids (KA) along with pharmacotherapy is recommended for patients with stage 4–5 chronic kidney disease (CKD). Research evidence on the effect of the diet on the rate of CKD progression is substantial and significant when study endpoints include the time of dialysis initiation. Correcting uremic intoxication symptoms allows starting hemodialysis (HD) at lower levels of residual renal function. In most cases, complications of CKD are associated with cardiovascular and metabolic disorders, reducing life expectancy and patients’ quality of life. Strict LPD with concurrent administration of ketoanalogues of essential amino acids enables preventing these disturbances. Finally, ketoanalogues of essential amino acids' supplementation coupled with regular monitoring of nutritional status allows avoiding the development of these disturbances, as evidenced by the absence of complications, affecting long-term outcomes in patients with pre-dialysis stage of the disease. Thus, strict LPD combined with administration of ketoanalogues of essential amino acids provides cardiovascular and renal protection. Due to its availability, efficiency and safety, this treatment modality may be applied in compliant CRD patients, allowing safely postpone the start of dialysis.

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41. Epub ahead of print


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