Ketoanalogs supplementation not only retarded kidney function deterioration but also reversed adverse outcomes in patients with advanced chronic kidney disease in a nationwide study

Background and aims: Chronic kidney disease (CKD) is one of the most burdensome health conditions worldwide and necessitates the preservation of kidney function. In recent years, ketoanalogs (KAs) and low-protein diets have been used to treat end-stage renal disease (ESRD). In this study, we used theNational Health Insurance Research Database(NHIRD) of Taiwan to explore the benefits of KAs in clinical practice. Methods: Data on patients with CKD were extracted from the NHIRD for the period 2000–2013. After the data of 7,883 patients were extracted, 1:3 case‒control matching was performed to minimize the differences between KA users and nonusers. A time-dependent Cox regression model and a generalized estimating equation method wereused to examine the clinical effects of KAs in patients with advanced CKD. Results: After 1:3 case‒control matching, the patients were divided into a KA group ( n = 369) and a non-KA group (control, n = 1,107). The patients in the KA group had a longer duration from the time point of CKD diagnosis to ESRD compared with those in the control group (30.9 versus 16.8 months, p < 0.0001). In addition, the patients in the KA group had a lower mortality rate, fewer blood transfusions, and fewer erythropoietin prescriptions per month (mortality rate: 14.6% versus 32.8%, p < 0.01; blood transfusions: 18.9% versus 33.8%, p < 0.01; erythropoietin prescriptions per month: 0.8 versus 1.1, p < 0.01). These results indicated that KAs had a positive effect on patients withCKD. Conclusion: KAs have a major effect on patients with advanced CKD, enabling them to defer dialysis, thereby mitigating their anemia and reducing their mortality risk. Our real-world clinical data demonstrate that low-protein diets and KAs can mitigate the adverse effects of CKD in patients with advanced CKD.