SP398LOW PROTEIN DIET SUPPLEMENTED WITH KETOANALOGUES IN PATIENTS WITH ADVANCED DIABETIC KIDNEY DISEASE AND SEVERE PROTEINURIA

Abstract

INTRODUCTION AND AIMS: Recent studies suggest that hypoproteic diets supplemented with ketoanalogues of essential aminoacids (sLPD) postpone dialysis, mainly by better metabolic and blood pressure (BP) control, and by reduction in proteinuria. However, few included diabetic patients. Thus, we aimed to evaluate the effects of sLPD on the rate of decline in renal function and on proteinuria in diabetic patients with CKD stage 4+ in an unicentric prospective interventional trial. METHODS: Two hundred and seventy-six adult diabetic patients with CKD stage 4+, with stable renal function, proteinuria > 3g/g creatininuria and good nutritional status (SGA A) were enrolled in a run-in phase (3 mo), when low protein diet (0.6g/kg dry ideal bw) was initiated. Those who proved adherent (n=92, 64% males, median age 55.7 yrs, 65% on insulin) were included in the study and received ketoanalogues supplemented (Ketosteril® , 1 tablet/10 kg dry ideal bw) low protein diet (sLPD). Monitoring and treatment continued according to the National Best Practice Guidelines. Efficacy was evaluated by the rate of decline in eGFR during intervention as compared to the pre-enrolment period (logistic regression, mL/min per mo) and the variation of proteinuria during intervention as primary parameters. Glucose metabolism and BP control were secondary variables. Nutritional and inflammation markers (SGA, BMI, serum albumin, C reactive protein, CRP) and compliance were safety variables. RESULTS: None of the patients required renal replacement therapy. The rate of decline in eGFR (mL/min per mo) decreased almost 5 times, from -0.5 (-0.6 to -0.5) before enrolment to -0.11 (-0.14 to -0.09) during sLPD (difference 0.40 [0.34 to 0.45]). Proteinuria significantly decreased and BP control was ameliorated. No influence of sLPD on glucose metabolism was noted. Nutritional status was improved: BMI decreased, with no change in SGA. Serum albumin significantly increased, while CRP decreased (Table 1). The protein and energy intake were constantly close to prescription. Initially low, adherence significantly improved (64 vs 38%). CONCLUSIONS: In patients with advanced Diabetic Kidney Disease and severe proteinuria, sLPD was associated with significant (5 times) reduction in the rate of decline in eGFR and of proteinuria (by 3.5g/g creatininuria). BP control, proteinuria, BMI and inflammation were ameliorated, but none of them appeared to be directly related to renal function, supporting the need for a plurifactorial intervention. (Figure presented).