Standard Ketoanalogue Dosage
The standard dosage of ketoanalogue formulation is 1 tablet per 5 kg body weight per day, typically administered in conjunction with a low-protein diet (0.3-0.6 g/kg/day). 1
Dosing Specifications
Standard Formulation (Ketosteril)
- Dosage: 1 tablet per 5 kg body weight per day 2
- This translates to approximately 0.2 tablets/kg/day for practical calculation
- Administered as part of a comprehensive dietary protein restriction strategy 1
Protein Restriction Context
The ketoanalogue dosing must be paired with appropriate protein restriction based on CKD stage 1:
- Very Low-Protein Diet (sVLPD): 0.3-0.4 g/kg/day (vegetarian) with ketoanalogue supplementation at 1 tablet/5 kg/day 3
- Low-Protein Diet (sLPD): 0.6 g/kg/day with the same ketoanalogue dosing 4
Evidence-Based Dosing Thresholds
Higher dosages show superior clinical outcomes 5:
- Dosages >5.5 tablets per day demonstrate significantly reduced risk of dialysis initiation and mortality 5
- This corresponds to patients weighing >27.5 kg requiring this minimum threshold for optimal benefit 5
Practical Calculation Example
For a 70 kg patient:
- Standard dose: 70 kg ÷ 5 = 14 tablets per day 2
- This exceeds the therapeutic threshold of 5.5 tablets, providing optimal benefit 5
Clinical Application by CKD Stage
CKD Stage 4-5 (Pre-dialysis) 1:
- Initiate at 1 tablet/5 kg/day with protein restriction
- Essential amino acids and ketoanalogues are specifically proposed to preserve renal function in conservatively treated CKD patients 1
Duration Considerations 1:
- For enteral nutrition <5 days: standard formulae acceptable
- For enteral nutrition ≥5 days: disease-specific formulae with ketoanalogues recommended 1
Important Clinical Caveats
Continuation is critical 4:
- Patients must continue ketoanalogue supplementation for >3 months to achieve significant reduction in dialysis risk 4
- Discontinuation before 3 months negates the protective benefits 4
Monitoring requirements 1:
- Strict monitoring of energy intake and nutritional status essential to prevent undernutrition 1
- Low-protein diets with ketoanalogues require careful oversight to avoid protein-energy wasting 1
Age-specific benefits 6:
- Mortality risk reduction appears more prominent in patients ≥70 years old (adjusted HR: 0.65) compared to younger patients (adjusted HR: 0.82) 6