Main aspects in the treatment of patients with chronic kidney disease stage IV–V and type II diabetes

Abstract

The article presents an overview of the up-to-date statistics on the incidence of chronic kidney disease (CKD) in Ukraine and worldwide. Nowadays, the main etiological factor of CKD in the world is diabetes and concomitant diabetic nephropathy, which is a complex multifactorial disease affecting multiple organs and systems. In Ukraine, the major part of these patients has CKD stage IV–V, which corresponds to the glomerular filtration rate (GFR) of 15–29 and < 15 ml/min/1.73 m2, respectively. Glycemic control and antihypertensive therapy are the primary links of the disease management in pre-dialysis, along with low-protein and low-carb diet. The key issue in treating these patients is that diet restrictions in pre-dialysis may lead to unfavorable consequences in terms of general nutritional status of the patient, so it is important to overcome this issue without interfering with patient’s biochemical status and avoiding the risk of loss of kidney function. The administration of ketoanalogues of essential amino acids in pre-dialysis is demonstrated to be effective in restoration of amino acid profile with protein anabolism, decreasing urea concentration in the blood and correcting mineral status. The positive effect is observed in patients with GFR < 25 ml/min/1.73 m2, where reported benefits start from GFR < 30 ml/min/1.73 m2, and are mostly prominent in patients with GFR < 15 ml/min/1.73 m2.

Keywords

• chronic kidney disease
• glomerular filtration rate
• diabetes
• diabetic nephropathy
• low-protein diet
• ketoanalogues of essential amino acids