From the Research
Alpha-keto analogs (AKAs) in chronic kidney disease (CKD) are generally well-tolerated, with common side effects including gastrointestinal disturbances, hypercalcemia, bad taste, and occasional allergic reactions, as reported in a 2024 systematic review and meta-analysis 1. The side effects of alpha-keto analogs in CKD can be managed with proper dosing and monitoring.
- Gastrointestinal disturbances such as nausea, vomiting, and diarrhea typically occur during the initial treatment period and often resolve with continued use.
- Hypercalcemia (elevated blood calcium levels) may occur due to the calcium salts in AKAs, requiring regular monitoring of calcium levels, especially in patients taking vitamin D supplements or calcium-based phosphate binders.
- Bad taste in the mouth and occasional allergic reactions have been reported.
- Rarely, patients may develop hyperglycemia, particularly those with pre-existing diabetes. To minimize side effects, AKAs (such as Ketosteril) should be taken with meals, starting at lower doses and gradually increasing as tolerated, as suggested by a 2024 study 2.
- The typical dosage is 1 tablet per 5-7 kg of body weight daily, divided into three doses with meals. Despite these potential side effects, AKAs remain valuable in CKD management as they help reduce nitrogen waste accumulation while providing essential amino acid precursors, potentially delaying dialysis initiation and preserving residual kidney function, as supported by a 2024 systematic review and meta-analysis 1. The most recent and highest quality study, a 2024 systematic review and meta-analysis 1, provides the strongest evidence for the side effects and benefits of AKAs in CKD management. Overall, the benefits of AKAs in CKD management, including delaying dialysis initiation and preserving residual kidney function, outweigh the potential side effects, making them a valuable treatment option for patients with CKD, as reported in a 2024 study 3.