Analysis of the Effectiveness of Renoprotection of Low-Protein Diet and Ketoanalogues of Amino Acids In Patients With Chronic Kidney Disease

Aim. Analysis of the effectiveness of renoprotection in patients with chronic kidney disease (CKD), who is observed by general practitioners for up to 72.1 months, keeping traditional LPD or LPD with prescription of ketoanalogues of amino acids (KA/AK). Methods. 63 patients with CKD stages 3-4, mainly with glomerulonephritis (GN), were divided into 3 groups: 1 gr - 31 patients (53.3 +/- 3.1 years old; M/F - 18/13), LPD with prescription of ketoanalogues of amino acids; 2 gr 22 patients (54.9 +/- 3.2 years old; M/F 13/9) traditional LPD without ketoanalogues; 3 gr 10 patients (51.7 +/- 4.2 years old; M/F 6/4) with natural course of CKD. Group 4 (control) 30 healthy subjects (52.3 +/- 2.2 years old; M/F 16/14). The following parameters were studied: dynamics of the glomerular filtration rate (GFR), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin levels (Hb), daily proteinuria, and basic parameters of protein, lipid and phosphate-calcium metabolism. Results. The rate of decline in GFR was significantly lower in patients of the first group (-0.78 mL/min/year) than those of the second group (-4.9 ml/min /year). 9.7% of patients of the first group needed the start of renal replacement therapy at the end of the observation, 18.1% - of the second group and 40% of the third. All patients who received renoprotective therapy, including low-protein diet with KA/AA reached target levels of blood pressure <140/90 mm Hg. Patients of this group was able to achieve a significant reduction in proteinuria, improvement of lipid metabolism, prevent of reduction of Hb and the development of metabolic disorders of protein and calcium-phosphate metabolism. The second group of patients, following nephroprotection recommendations and LPD without KA/AA, had fewer reductions in SBP without reaching the target level, DBP did not change; reduction of proteinuria was less significant than in group 1. There was no negative dynamics of protein and calcium-phosphate metabolism, though significantly increased levels of total cholesterol and LHD were observed. The third group of patients, who did not follow the renoprotection recommendations demonstrated negative dynamics of the studied parameters. Conclusion. Renoprotection based on the use KA/AA in patients with CKD stages 3-4 proved to be more effective than without it in slowing the rate of decline in GFR, hypertension correction, proteinuria reduction, maintaining the level of Hb, prevention of disorders of protein and calcium-phosphate metabolism, as well as correction of the lipid metabolism.