Chulalongkorn Medical Journal


Imbalance of protein degradation and synthesis is known as a common complication of chronic kidney disease (CKD) and finally leads to protein energy wasting. Nutritional intervention including protein-restricted strategy plays an important part of integrated CKD management. Dietary therapy can retard the loss of residual renal function and alter metabolism of various amino acids. However, low-protein diet may worsen the patients’ malnutrition status and promote loss of body protein store. The implementation of nutritional treatment by using ketoanalogues of essential amino acids or keto acids is promising. Their structures are similar to other amino acids but contain no amine group which produces nitrogen waste products. Although not proven conclusively, there is ample evidence that nitrogen-free ketoanalogues can provide less degree of uremic symptoms, metabolic acidosis, hyperphosphatemia and slow CKD progression in both early and late predialysis patients.

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