Ketoanalogue Tablet Dosage
Ketoanalogue supplements are not standardized by tablet weight in milligrams, but rather dosed by the number of tablets based on body weight, with the standard dosing being 1 tablet per 5 kg of body weight per day.
Understanding Ketoanalogue Formulations
The most commonly used ketoanalogue preparation (Ketosteril) contains a mixture of keto acids and amino acids rather than a single compound, making "mg per tablet" an imprecise measure 1, 2. Each tablet contains multiple active ingredients including keto analogues of valine, leucine, isoleucine, methionine, and phenylalanine, along with other essential amino acids 3.
Standard Dosing Protocol
The universal dosing recommendation across clinical studies is 1 tablet per 5 kg of body weight per day 1, 2. For example:
- A 60 kg patient would receive 12 tablets daily
- A 75 kg patient would receive 15 tablets daily
- An 80 kg patient would receive 16 tablets daily
This weight-based dosing has been consistently used in clinical trials demonstrating efficacy, with daily doses typically ranging from 6-14 grams of total ketoacid salts (as sodium or calcium salts) 3, 1.
Clinical Context and Dietary Integration
Ketoanalogues are prescribed as part of a comprehensive nutritional strategy for chronic kidney disease management 4, 5. The KDOQI guidelines recommend that ketoanalogue supplementation be combined with very low-protein diets (0.28-0.43 g dietary protein/kg body weight/day) to meet total protein requirements of 0.55-0.60 g/kg body weight/day in adults with CKD 3-5 4.
Important Clinical Considerations
Ketoanalogues must be combined with appropriate dietary protein restriction to be effective - they are not standalone supplements 6, 1. Studies show that ketoanalogue-supplemented vegetarian very low-protein diets can defer dialysis initiation, with a number needed to treat of 2.7 for patients with eGFR <20 mL/min per 1.73 m² 6.
The supplements are generally well-tolerated with no significant adverse effects or nutritional depletion when properly monitored 5, 1. However, effectiveness may be reduced in patients with very advanced kidney disease and high blood urea levels until after dialysis 3.