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.

journal_name

Semin Dial

journal_title

Seminars in dialysis

authors

Aparicio M,Bellizzi V,Chauveau P,Cupisti A,Ecder T,Fouque D,Garneata L,Lin S,Mitch W,Teplan V,Yu X,Zakar G

doi

10.1111/sdi.12132

subject

Has Abstract

pub_date

2013-11-01 00:00:00

pages

714-9

issue

6

eissn

0894-0959

issn

1525-139X

journal_volume

26

pub_type

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