SP389KETOANALOGUE TREATMENT IN CKD: +PRELIMINARY RESULTS FROM CKDOD

Abstract

INTRODUCTION AND AIMS: The Chronic Kidney Disease Observational Database (CKDOD) is designed to assess the association between different factors with a known influence on chronic kidney disease (CKD) progression as well as treatment strategies such as dietary modifications, blood pressure control and pharmacological interventions in Asian countries (India, China, Malaysia and Thailand). Here we report safety of low protein diet (LPD) with or without ketoanalogues (KA) in terms of markers of nutritional status. We also report preliminary data regarding efficacy of KA supplementation on kidney disease progression. METHODS: The only inclusion criterion is the presence of CKD stage 2 or higher as defined by the KDIGO guidelines. Demographic and clinical information are collected by a standardised electronic questionnaire, available in English and Chinese. Collection of data started in September 2011 and by December 2016, data on 948 individual patients are available for analysis. RESULTS: Out of 948 patients included in the study, KAs were prescribed in 298 patients. There were no differences in age (59 vs 58 years), gender (28% vs 34% female), diabetic status (39% vs 32%) and body mass index (24.7 vs 25.2 kg per mtsq). Body weight, serum total protein and albumin concentrations did not differ between groups at baseline and over the follow up period (2 years). In patients who had at least 2 serum creatinine measurements available, there was no significant difference in eGFR decline between KA and no-KA groups over 2 years; -0.5 +/- 6.2 (N=101) vs. -1.5 +/- 7.1 ml/min/1.73m2 (N=167), respectively, p=0.24). Similarly, dialysis free survival was not different between both groups. Subgroup analysis of patients with diabetes mellitus, there was a similar trend showing that diabetic patients receiving KA showed a numerically less decline in eGFR, which did not reach statistical significance (-0.9 +/- 6.9 ml/ min/1.73m2 (N=40) versus -1.9 +/- 7.4 ml/min/1.73m2 (N=49), p = NS). CONCLUSIONS: Preliminary results of the CKDOD registry suggest that protein restricted diets supplemented with ketoanalogues are not associated with a significant nutritional risk in CKD patients with Asian ancestry. In patients with diabetes mellitus, a trend towards less decline in eGFR might suggest a potential benefit specifically for subgroups with metabolic abnormalities.