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Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients?
Semin Dial. 2013 Nov-Dec; 26(6):714-9.SD

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.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Aparicio M
Nephrology Department, Hopital Pellegrin et Université Bordeaux II, Bordeaux, France.
Bellizzi V
No affiliation info available
Chauveau P
No affiliation info available
Cupisti A
No affiliation info available
Ecder T
No affiliation info available
Fouque D
No affiliation info available
Garneata L
No affiliation info available
Lin S
No affiliation info available
Mitch W
No affiliation info available
Teplan V
No affiliation info available
Yu X
No affiliation info available
Zakar G
No affiliation info available

MeSH

Amino Acids, EssentialDiet, Protein-RestrictedDietary SupplementsHumansPatient SelectionRenal DialysisRenal Insufficiency, ChronicTime FactorsTime-to-Treatment

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24016150

Citation

Aparicio, Michel, et al. "Do Ketoanalogues Still Have a Role in Delaying Dialysis Initiation in CKD Predialysis Patients?" Seminars in Dialysis, vol. 26, no. 6, 2013, pp. 714-9.
Aparicio M, Bellizzi V, Chauveau P, et al. Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients? Semin Dial. 2013;26(6):714-9.
Aparicio, M., Bellizzi, V., Chauveau, P., Cupisti, A., Ecder, T., Fouque, D., Garneata, L., Lin, S., Mitch, W., Teplan, V., Yu, X., & Zakar, G. (2013). Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients? Seminars in Dialysis, 26(6), 714-9. https://doi.org/10.1111/sdi.12132
Aparicio M, et al. Do Ketoanalogues Still Have a Role in Delaying Dialysis Initiation in CKD Predialysis Patients. Semin Dial. 2013 Nov-Dec;26(6):714-9. PubMed PMID: 24016150.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients? AU - Aparicio,Michel, AU - Bellizzi,Vincenzo, AU - Chauveau,Philippe, AU - Cupisti,Adamasco, AU - Ecder,Tevfik, AU - Fouque,Denis, AU - Garneata,Liliana, AU - Lin,Shanyan, AU - Mitch,William, AU - Teplan,Vladimir, AU - Yu,Xueqing, AU - Zakar,Gabor, Y1 - 2013/09/09/ PY - 2013/9/11/entrez PY - 2013/9/11/pubmed PY - 2014/7/26/medline SP - 714 EP - 9 JF - Seminars in dialysis JO - Semin Dial VL - 26 IS - 6 N2 - 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. SN - 1525-139X UR - https://www.unboundmedicine.com/medline/citation/24016150/Do_ketoanalogues_still_have_a_role_in_delaying_dialysis_initiation_in_CKD_predialysis_patients L2 - https://doi.org/10.1111/sdi.12132 DB - PRIME DP - Unbound Medicine ER -