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Supplemented Very Low Protein Diet and the Progression of Chronic Kidney Disease (KETOPROG)

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ClinicalTrials.gov Identifier: NCT02031224
Recruitment Status : Completed
First Posted : January 9, 2014
Last Update Posted : December 22, 2017
Sponsor:
Collaborator:
Dr Carol Davila Teaching Hospital of Nephrology Bucharest
Information provided by (Responsible Party):
Liliana Garneata, Carol Davila University of Medicine and Pharmacy

Brief Summary:
This is a prospective single center randomized controlled trial with a total duration of 18 months aiming to evaluate the effectiveness and the safety of a very low protein diet supplemented with ketoanalogues of essential aminoacids in reducing the progression of chronic kidney disease (CKD) in patients with advanced CKD.

Condition or disease Intervention/treatment Phase
Chronic Kidney Disease Behavioral: Conventional low protein diet Dietary Supplement: Very low protein diet supplemented with Ketosteril Phase 4

Detailed Description:

All eligible patients who will give informed consent will be screened. Those meeting the selection criteria will be enrolled and will enter a 3-month run-in phase during which a conventional LPD will be prescribed in all patients.

At the end of this phase, the subjects still fulfilling all the selection criteria will be randomized in a 1:1 ratio to receive the KD or to continue the conventional LPD for a total duration of 15 months.

Nineteen blood and urine samplings are scheduled for each patient, to be drawn monthly. The laboratory reports include the nitrogen compounds, calcium-phosphorus metabolism parameters, acid-base balance, biochemical nutritional markers, serum C-reactive protein, hemoglobin, blood cell count, and biochemical safety parameters (sodium, potassium, liver enzymes, and bilirubin).

The anthropometric measurements and subjective global assessment will be evaluated at enrolment, at randomization, and every 3 months thereafter.

The compliance with the prescribed diet (protein and energy intake) will be assessed monthly during the run-in phase, weekly for the first month after randomization, every 4 weeks during the next 6 months, and every 3 months thereafter.

The blood pressure levels, drugs required for the therapy of hypertension, acidosis and mineral metabolism disorders, and occurrence of adverse events will be recorded monthly.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 250 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Effect of Very Low Protein Diet Supplemented With Ketoanalogues of the Essential Amino Acids on the Progression of Chronic Kidney Disease
Study Start Date : March 2008
Actual Primary Completion Date : June 2014
Actual Study Completion Date : August 2014

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Kidney Diseases

Arm Intervention/treatment
Experimental: Keto-diet (KD)
Patients in the intervention arm (KD group) will receive a vegetarian very low protein diet (0.3 g proteins/kg ideal body weight per day) supplemented with ketoanalogues of essential amino acids (Ketosteril®, Fresenius Kabi, Bad Homburg, Germany), 1 capsule for every 5 kg of ideal dry body weight per day.
Dietary Supplement: Very low protein diet supplemented with Ketosteril
Other Name: SVLPD, Keto-diet

Active Comparator: Low Protein Diet group (LPD)

The patients in the control arm (LPD group) will continue their conventional low protein diet, with 0.6 g/kg per day (including high biological value proteins).

The total recommended energy intake is of 30 kcal/kg of ideal dry body weight per day in both arms.

Behavioral: Conventional low protein diet
Other Names:
  • LPD
  • Hypoproteic diet




Primary Outcome Measures :
  1. Primary composite endpoint [ Time Frame: 15 months after randomization ]
    Need for renal replacement therapy or an at least 50% reduction in the estimated glomerular filtration rate compared to randomization


Secondary Outcome Measures :
  1. Secondary efficacy parameter [ Time Frame: months 3-15 after randomization ]
    The rate of decline in the estimated Glomerular Filtration Rate

  2. Secondary outcome measure - nitrogen balance [ Time Frame: 15 months after randomization ]
    variations in serum urea

  3. Secondary efficacy parameter - mineral metabolism [ Time Frame: 15 weeks after randomization ]
    variations in total serum calcium

  4. Secondary efficacy parameter [ Time Frame: 15 weeks after randomization ]
    variations in serum phosphate level

  5. Secondary efficacy parameter [ Time Frame: 15 weeks after randomization ]
    variations in serum bicarbonate

  6. Secondary safety parameter [ Time Frame: 18 weeks after enrolment ]
    Subjective Global Assessment of the nutritional status

  7. Secondary safety parameter [ Time Frame: 18 weeks after enrolment ]
    Body Mass Index

  8. Secondary outcome measure - Nutritional status [ Time Frame: 18 weeks after enrolment ]
    Tricipital skinfold

  9. Secondary safety parameter - anthropometric measures [ Time Frame: 18 weeks after enrolment ]
    Mid-arm muscular circumference

  10. Nutritional status - biochemical markers [ Time Frame: 18 weeks after enrolment ]
    serum albumin

  11. Inflammation [ Time Frame: 18 weeks after enrolment ]
    serum level of C reactive protein

  12. Nutritional status - biochemical marker [ Time Frame: 18 weeks after enrolment ]
    Serum total cholesterol

  13. Secondary safety parameter [ Time Frame: 18 weeks after enrolment ]
    Serum potassium level

  14. Secondary safety parameter [ Time Frame: 18 weeks after enrolment ]
    liver enzymes: Aspartate Aminotransferase, Alanine Transaminase

  15. Safety parameter - adverse events [ Time Frame: 18 weeks after enrolment ]
    Occurrence of any adverse event

  16. Secondary safety parameter - withdrawals [ Time Frame: 18 weeks after enrolment ]
    number of withdrawals


Other Outcome Measures:
  1. Compliance - protein intake [ Time Frame: 18 months after enrolment ]
    urinary urea nitrogen excretion to calculate the protein intake

  2. Compliance - energy intake [ Time Frame: 18 weeks after enrolment ]
    3-day food diary to calculate the daily energy intake



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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • adult non-diabetic patients
  • stage 4-5 CKD not on dialysis (estimated glomerular filtration by Modification of Diet in Renal Disease formula < 30 mL/min per year
  • stable renal function at least 12 weeks before enrollment
  • well-controlled arterial blood pressure
  • proteinuria less than 1 g/g urinary creatinine
  • good nutritional status
  • declared and anticipated good compliance with the prescribed diet

Exclusion Criteria:

  • poorly controlled arterial blood pressure (≥145/85 mm Hg)
  • relevant comorbid conditions (diabetes mellitus, heart failure, active hepatic disease, digestive diseases with malabsorption, inflammation/anti-inflammatory therapy)
  • uremic complications (pericarditis, polyneuropathy)
  • feeding inability (anorexia, nausea)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02031224


Locations
Romania
"Dr Carol Davila" Teaching Hospital of Nephrology
Bucharest, Romania, 010731
Sponsors and Collaborators
Anemia Working Group Romania
Dr Carol Davila Teaching Hospital of Nephrology Bucharest
Investigators
Study Chair: Gabriel Mircescu, Prof Carol Davila University of Medicine and Pharmacy

Publications of Results:
Responsible Party: Liliana Garneata, Assistant Professor of Nephrology, MD, PhD, Carol Davila University of Medicine and Pharmacy
ClinicalTrials.gov Identifier: NCT02031224     History of Changes
Other Study ID Numbers: AWG13/2007
First Posted: January 9, 2014    Key Record Dates
Last Update Posted: December 22, 2017
Last Verified: December 2017

Keywords provided by Liliana Garneata, Carol Davila University of Medicine and Pharmacy:
Chronic Kidney Disease
Restricted protein diets
Nutritional status

Additional relevant MeSH terms:
Kidney Diseases
Renal Insufficiency, Chronic
Urologic Diseases
Renal Insufficiency