Inclusion Criteria Were RRF As Above

While a low-protein diet may preserve residual renal function (RRF) in chronic kidney disease (CKD) patients before the start of dialysis, a high-protein intake is usually recommended in dialysis patients to prevent protein-energy wasting. Keto acids, which were often recommended to pre-dialysis CKD patients treated with a low-protein diet, had also been reported to be associated with both RRF and nutrition maintenance. We conducted a randomized trial to test whether a low-protein diet with or without keto acids would be safe and associated with a preserved RRF during peritoneal dialysis (PD). Methods. To assess the safety of low protein, we first conducted a nitrogen balance study in 34 incident PD patients randomized to receive in-centre diets containing 1.2, 0.9 or 0.6 g of protein/kg ideal body weight (IBW)/day for 10 days. LP: 0.6-0.8 g/kg IBW/day), keto acid-supplemented low- (sLP: 0.6-0.8 g/kg IBW/day with 0.12 g/kg IBW/day of keto acids) or high-protein (HP: 1.0-1.2 g/kg IBW/day) diet.

The groups were followed for 1 year and RRF as well as nutritional status was evaluated serially. Results. A neutral or positive nitrogen balance was achieved in all three groups. 1 month met the recruitment criteria. The patients could withdraw from the study at any stage as per their own will. PD was performed using a 1.5% or 2.5% dextrose solution (Dianeal; Baxter China Ltd, Guangzhou, China) with Twin Bag system (UltraBag; Baxter China Ltd). The patients were hospitalized and randomized to receive in-centre meals containing a net DPI of 1.2, 0.9 or 0.6 g/kg IBW. Approximately half of this protein was from animal products. 35 kcal/kg IBW for patients below 60 years of age, and 30 kcal/kg IBW for the rest. Based upon actual food consumption, DPI and TEI was calculated (Keto Acids Diet Calculator 2.0; Fresenius-Kabi Co., Ltd, Beijing, China). After a 3-day wash-in period, baseline data were collected and patients were then followed for 10 days. Nitrogen balance, nutritional markers and blood biochemistry were assessed at baseline and after 7 and 10 days.

All the laboratory measurements were performed using routine methods. A simplified nitrogen balance was calculated as described by Rao et al. Briefly, nitrogen (N) input was calculated from DPI. N output included estimated values of dialytic and urinary nitrogen losses based on measured urea losses (urea nitrogen, UN). The sum of faecal losses and other nitrogen losses (through skin, sweat and breath) that we assumed did not change significantly with a protein intake was estimated using the value 0.031 g/kg/day suggested by Maroni et al. Stable PD patients with urine output ≥800 ml or eGFR ≥2 ml/min/1.73 m2 (calculated as an average of the creatinine and urea clearances by 24-h urine) were evaluated. Inclusion criteria were RRF as above, age 18- 80 years, stable PD for at least 1 month. Exclusion criteria were a high probability (assessed by the recruiting physician) of receiving a kidney transplant within 1 year; overt infection within the last month; persistent anorexia, vomiting or diarrhoea and the presence of wasting diseases such as cancer or tuberculosis.

The patients were randomized to either a low- (LP: 0.6-0.8 g/kg IBW/day), keto acid-supplemented low- (sLP: 0.6-0.8 g/kg IBW/day with keto acids of 0.12 g/kg IBW/day, Ketosteril; Fresenius-Kabi Co.) or high-protein (HP: 1.0-1.2 g/kg IBW/day) diet based on the results of the nitrogen balance study. TEI was prescribed as above. During a 1-month wash-in period after randomization, patients were repeatedly instructed by dietitians on how to prepare their food and record the actually consumed food. Then, baseline data, such as RRF, Kt/V and blood biochemistry, etc, were collected and enrolled patients were assessed serially for 12 months, and diet, RRF, nutritional status, as well as blood chemistry followed. PD was performed in the same way as the nitrogen balance study. Angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin II receptor blockers (ARBs) were given to all the patients during the study to control hypertension. Amino acids and other nutritional supplements were avoided during the study. Aminoglycosides were forbidden for patients with RRF when infection occurred during follow-up. The protein equivalent of nitrogen contained in keto acids was added to DPI of group sLP. RRF was assessed as above, while dialysis adequacy was assessed using Kt/V and creatinine clearance. All the other parameters were measured using routine procedures. The results are presented as mean ± SD or median (interquartile range).

If keto is taking away your ability to connect with loved ones, reconsider. When you go on keto, everyone will warn you about the keto flu, a time when your body is adjusting to fat burning and you often have symptoms of illness. You should start to feel better after a couple weeks, but if you still feel awful, you may not be properly fueling your body. It may also be a good idea to work with your doctor and get lab tests taken after being on keto to see how your body is responding. Those can give you a clue that things aren’t going as planned. Ware has tried keto. She experienced a significant jump in her cholesterol levels, and she had never had high cholesterol before. “There’s a debate on what higher cholesterol numbers on keto mean, but for me, this was another sign that my body didn’t like eating this way,” she says. RELATED: Can the Keto Diet Help Prevent or Manage Heart Disease?