SP373VEGETARIAN VERY LOW PROTEIN DIET SUPPLEMENTED WITH KETOANALOGUES IN STAGE 5 CKD PATIENTS

Abstract

INTRODUCTION AND AIMS: Protein‐restricted diet was reported to delay renal replacement therapy (RRT) in Chronic Kidney Disease (CKD) patients. Effectiveness in patients with stage 5 CKD was seldom studied. We aimed to test whether the vegetarian very low protein diet supplemented with ketoanalogues (KD) could be more effective than a conventional low protein diet (LPD) in prolonging the time from a glomerular filtration rate (GFR) of 15mL/min to the composite end‐point of more than 50% reduction in eGFR or RRT initiation. METHODS: Non‐diabetic adult patients with stable CKD stage 4+, proteinuria<1g/g, good nutritional status and good dietary compliance were enrolled in the single center, prospective, randomized controlled trial and entered a 3‐month run‐in‐phase, on LPD. Compliant patients (203) were randomized to receive for 15 months either KD or continue LPD (no differences between groups) (results published).Only the patients reaching a eGFR lower than 15mL/min at any moment during the intervention period were selected for this analysis: only 38 (17 on KD and 21 on LPD) of the 203 patients (102 on KD).The slope of eGFR was calculated by linear regression of values recorded at study moments: from month 1 to eGFR<15mL/min and from eGFR<15mL/min to the composite endpoint. RESULTS: Estimated GFR decreased significantly slower in the KD group only after the <15mL/min level was reached (Month 9) (Figure 1).For eGFR <15mL/min, eGFR slope was significantly lower in KD group:‐0.22 (‐0.32,‐0.03) versus‐0.61 (‐1.22,‐0.28), mL/min per month. Only 10 patients reached the composite end‐point, without differences between groups. There was no difference in the event‐free survival of groups: 49.3 (36.3, 62.4) versus 49.3 (36.3 versus 62.4), weeks (limitation: low number of patients. CONCLUSIONS: KD seem to be more effective than LPD to prevent RRT or severe worsening of renal function for eGFR lower than 15mL/min.