The study of effect of ketoanalogues in delaying progression of chronic kidney disease in patients with diabetic nephropathy

Abstract

It has been proposed that protein-restricted diets may slow down the rate of progression and change the prognosis of patients with progressive CKD. The present study was conducted to assess the clinical efficacy and safety of low protein diet (LPD) supplemented with ketoanalogues (KA) in the treatment of diabetic nephropathy (DN) in comparison with LPD alone. Forty eight Diabetic Nephropathy patients at B.A.R.C. hospital, Mumbai were selected for participation in the study and were randomized to receive either LPD (0.6g/kg BW/day) + ketoanalogues or the control treatment of LPD (0.6g/kg BW/day). Both the groups received the treatment for mean duration of 31 months and followed up for 5 years. Renal functions, nutritional and metabolic status were assessed and compared at periodic intervals and at the end of 5 years follow up. The baseline characteristics, disease severity, renal dysfunction, metabolic derangements and demographic parameters were matched in both the groups. Serum creatinine was 2.44 and 2.32mg/dL in study and control groups respectively at baseline, GFR in study and control group was 33.42 and 40.13mL/min/1.73 m2 respectively at baseline. Serum PTH levels at baseline in study and control group was 125.14 and 100.97pg/mL respectively. At the end of 5 years, serum creatinine was 2.84 and 3.48mg/dL, GFR was 8.08 and 7.38 13mL/min/1.73m2 , serum PTH was 519.96 and 707.23pg/mL in study and control groups respectively. Serum phosphorous levels in study group and control group at baseline were 4.06 and 3.94mg/dL respectively. At the end of 5 years these levels were 3.84 and 4.0/dL respectively. The detail statistical analysis and other observations will be presented. It has been observed that LPD+KA is superior to LPD in delaying the progression of CKD towards the ESRD. It is also superior to LPD in decreasing the serum phosphorus levels and thus delaying the occurrence of secondary parahyperthyroidism and renal osteodystrophy. In maintaining the nutritional status of the patients, Glycemic control and blood pressure control, LPD+KA has played a role superior to that of LPD.