From the Guidelines
Alpha-ketoanalogues (α-KAs) should not be routinely recommended for Acute Kidney Injury (AKI) management due to the lack of high-quality evidence specifically addressing AKI, as noted in the 2021 ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease 1. The current evidence primarily focuses on the use of α-KAs in chronic kidney disease, with limited studies exploring their potential benefits in AKI. However, α-KAs may have theoretical benefits in AKI through:
- Reducing nitrogen load and uremia
- Decreasing inflammation and oxidative stress
- Preserving muscle mass in catabolic states
- Possibly slowing AKI progression No specific dosing regimen can be recommended for AKI at this time due to the lack of clinical trials, but if considered, dosing would likely be similar to CKD protocols, typically 0.1-0.2 g/kg/day of α-KAs, as suggested by expert opinions in the context of nutritional management in kidney disease 1. The potential benefits of α-KAs in AKI stem from their ability to provide essential amino acid precursors without additional nitrogen load, potentially reducing metabolic stress on injured kidneys. Nevertheless, more research is needed to establish efficacy, safety, and optimal use in AKI before α-KAs can be considered standard therapy.
From the Research
Role of Alpha-Ketoanalogues in Acute Kidney Injury Management
There are no research papers to assist in answering this question as the provided studies focus on the effects of ketoanalogues on chronic kidney disease (CKD) and not specifically on acute kidney injury (AKI) management.
Effects of Ketoanalogues on Chronic Kidney Disease
- Ketoanalogues have been shown to maintain nutritional status in patients with CKD on a restricted protein diet 2, 3, 4.
- Ketoanalogues may slow down the progression of CKD in patients with an estimated glomerular filtration rate (eGFR) > 18 mL/min/1.73 m2 3.
- Ketoanalogues may reduce uremic toxins production, acidosis, phosphorus, and sodium intake, while providing adequate calcium intake 4.
- Ketoanalogues may reduce mortality in patients with pre-dialysis advanced diabetic kidney disease 5.