Effect of essential amino acid ketoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and ?lotho) in 3b-4 stages chronic kidney disease patients: a randomized pilot study

BackgroundA low protein diet (LPD) with essential amino acid ketoanalogue supplementation (KA) may contribute in improving of chronic kidney disease (CKD), while the exact mechanisms of KA's effect are not established yet. We have conducted a prospective, randomized, controlled comparative study of LPD+KA and LPD alone in relation to serum Klotho, FGF-23 levels in CKD patients.Methods79 non-diabetic CKD 3b-4 stage patients, compliant with LPD diet (0.6g/kg of body weight/day), had been selected. The patients were randomized into two groups. The first group (42 patients) received LPD + ?A. The second group (37 patients) continued the L?D alone. In addition to routine tests, serum Klotho, FGF-23 levels, as well as bioimpedance analysis, sphygmography (stiffness (augmentation) indices (AI), central (aortal) blood pressure) with a << SphygmaCor >> device; echocardiography (valvular calcification score (VCS) and LVMMI), were performed.ResultsThere were body mass indices' decrease (p=0.046), including muscle body mass in men (p=0.027) and woman (p=0.044) in the LPD group to the end of study (14th month). In addition, lower FGF-23 (p=0.029), and higher sKlotho (p=0.037) were detected in the LPD+KA group compared to the LPD one. The increase in AI (p=0.034), VCS (p=0.048), and LVMMI (p=0.023) was detected more often in the LPD group at the end of study.ConclusionLPD+KA provides support for nutrition status and contributes to more efficient correction of FGF-23 and Klotho abnormalities that may result in cardiovascular calcification and cardiac remodeling decreasing in CKD. At the same time, a prolonged LPD alone may lead to malnutrition.