Keto Analogues: What Are They Good For?

Ketoanalogues (KAs) are nitrogen-free analogues of essential amino acids. They can be used as a supplement to a low-protein diet (LPD) or a very-low-protein diet (VLPD) to slow the progression of chronic kidney disease (CKD). KAs are converted to the respective amino acids without producing toxic nitrogenous waste products. They can be especially useful for patients with diabetic kidney disease (DKD).

Keto analogues are used to slow the progression of chronic kidney disease (CKD)

Keto analogues are forms of amino acids, the building blocks of protein, without the amino group bound to the alpha carbon. This means they can be converted into essential amino acids without providing additional nitrogen, which can be harmful to kidney health as it can build up. A low or very low protein diet supplemented with keto analogues can help reduce the nitrogen load on the kidneys and improve nutritional parameters.

The use of keto analogues with a low or very low protein diet is supported by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and is widely used in Europe, Asia, and other parts of the world. Research has shown that this approach can reduce CKD progression, slow the onset of uremic symptoms, and improve nutritional markers.

Keto analogues have also been found to have additional benefits for CKD patients, including decreased serum creatinine and blood urea nitrogen levels, improved calcium and phosphorus management, and better blood pressure control. However, it is important to note that keto analogues should be used under medical supervision and are not suitable for everyone with kidney disease. They are typically recommended for mid to late-stage CKD and may not be covered by health insurance.

They are used to reduce the risk of end-stage kidney disease and death

Ketoanalogues are used to reduce the risk of end-stage kidney disease and death. They are a medical food created specifically for kidney patients. Ketoanalogues are a portion of amino acids, which are the building blocks of protein. They play many roles in the body, beyond protein and muscle synthesis, such as the synthesis of hormones, neurotransmitters, enzymes, transporters, tissues, and cells.

The body cannot produce essential amino acids, so we must obtain them through our diet. Ketoanalogues are a breakdown form of amino acids, but they do not include the part of amino acids that can be harder on the kidneys—nitrogen. Nitrogen is harmful to kidney health as it can build up.

Ketoanalogues are typically recommended for mid- and late-stage chronic kidney disease (CKD). They are used in conjunction with a low or very-low protein diet. The low protein diet is anywhere from 0.55 to 0.8 grams of protein per kilogram of body weight. The very-low protein diet is a diet with 0.28 to 0.43 grams of protein per kilogram of body weight, along with ketoanalogues to meet protein requirements.

The use of a low or very-low protein diet supplemented with ketoanalogues has been shown to reduce CKD progression, slow the onset of uremic symptoms, and improve nutritional parameters and markers. Ketoanalogues can help prevent protein wasting, malnutrition, and deficiencies for someone on a very-low or low protein diet. They can also help to delay the start of dialysis.

Research has shown that stage 4 CKD patients can safely benefit from adding ketoanalogues to a low protein diet to prevent the start of dialysis. In some cases, those who start dialysis and have a small percentage of kidney function remaining may be advised to use ketoanalogues. It's important to note that ketoanalogues are not used to stop dialysis treatment.

Ketoanalogues have been studied for many years to determine their benefits for those with kidney disease. Some potential benefits include decreased serum creatinine and blood urea nitrogen levels, lower oxidative stress, decreased metabolic acidosis, better phosphorus and parathyroid hormone level management, decreased insulin resistance, improved blood pressure, and protected lean muscle mass.

An observational study in 2018 found that a group following a low protein diet with ketoanalogue supplementation had a lower risk of all-cause mortality, cardiovascular and cerebrovascular events, and infection-related death. A study published in 2021 found that ketoanalogue supplements reduced mortality in CKD patients not on dialysis with diabetic kidney disease.

Keto analogues are used to improve quality of life

Keto analogues are used to improve the quality of life for people with chronic kidney disease (CKD). They are a medical food created specifically for kidney patients.

Keto analogues are a form of amino acid, the building blocks of protein. However, they do not include nitrogen, which is harmful to kidney health as it can build up.

Keto analogues are typically used in conjunction with a low or very-low protein diet to slow the progression of CKD, improve nutrition, and delay the need for dialysis.

According to the 2020 KDOQI Clinical Practice Guideline For Nutrition in CKD, for adults with CKD 3-5 who are metabolically stable, protein restriction with or without keto acid analogues is recommended to reduce the risk of end-stage kidney disease and improve quality of life.

Keto analogues have been shown to have several potential benefits for people with CKD, including:

• Decreased serum creatinine and BUN levels
• Lower oxidative stress
• Decreased metabolic acidosis
• Improved phosphorus and parathyroid hormone level management
• Decreased insulin resistance
• Improved blood pressure
• Protection of lean muscle mass
• Delayed start of dialysis

However, it is important to note that keto analogues should be used under medical supervision and are not suitable for everyone with CKD. They are typically recommended for mid- to late-stage CKD and are not covered by health insurance, which can be a barrier to access.

They are used to prevent malnutrition

Ketoanalogues are used to prevent malnutrition in people with chronic kidney disease (CKD) by providing essential amino acids without the nitrogen that can be harmful to kidney health as it can build up. They are a medical food created specifically for kidney patients.

Ketoanalogues are a form of essential amino acids, which are the building blocks of protein. However, they do not include nitrogen, which can be harmful to kidney health as it can build up.

A ketoanalogue-supplemented very-low-protein diet (VLPD) has been shown to be effective in reducing the loss of the glomerular filtration rate (GFR) in addition to the beneficial effects of renin-angiotensin-aldosterone system (RAAS) inhibitors.

VLPD + KAs appear nutritionally safe and seem to reduce uremic toxins production. All studies observed a reduction of acidosis, phosphorus, and possibly sodium intake, while still providing adequate calcium intake.

The current evidence suggests that KAs supplemented LPD diets should be included as part of the clinical recommendations for both the nutritional prevention and metabolic management of CKD.

They are used to manage chronic kidney disease

Keto analogues are used to slow down the progression of chronic kidney disease (CKD) and delay the need for dialysis. CKD is characterised by the accumulation of organic solutes called uremic toxins, which are produced by the degradation of dietary amino acids by intestinal microbiota. A reduction in protein intake can preserve renal function and reduce uremic toxicity.

Keto analogues are nitrogen-free essential amino acids used in conjunction with a very low-protein diet. They can be utilised in place of their respective amino acids without providing nitrogen waste products. The addition of keto analogues can help improve deficiencies and nitrogen balance.

Keto analogues are used to manage CKD by reducing uremic toxins, correcting metabolic acidosis, and improving mineral metabolism. They can also be used to reduce the need for dialysis.

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