What is the recommended dose of Ketosteril (alpha-ketosteril) in patients with Chronic Kidney Disease (CKD)?

From the Guidelines

Ketosteril is typically dosed at 1 tablet per 5 kg of body weight per day for patients with chronic kidney disease (CKD). For most adults, this translates to 4-8 tablets daily, divided into three doses taken with meals. For example, a 70 kg patient would take approximately 14 tablets daily, which could be divided as 5 tablets with breakfast, 4 with lunch, and 5 with dinner. The tablets should be taken during meals to maximize absorption and effectiveness. Ketosteril contains essential amino acids and their ketoanalogues, which help maintain protein nutrition while reducing nitrogen intake in CKD patients. This is particularly important for patients on low-protein diets (0.3-0.4 g/kg/day), as it helps prevent malnutrition while reducing the workload on the kidneys. The medication works by providing amino acid precursors without the nitrogen component, which would otherwise need to be processed and excreted by the already compromised kidneys. Treatment should be supervised by a nephrologist who can adjust dosing based on the patient's specific condition, weight, dietary protein intake, and kidney function parameters.

Some key points to consider when dosing Ketosteril in CKD patients include:

• The dose may need to be adjusted based on the patient's kidney function and protein intake 1
• The medication should be taken with meals to maximize absorption and effectiveness
• Patients with CKD should be monitored closely for signs of malnutrition and electrolyte imbalances
• The dose of Ketosteril may need to be reduced in patients with severe kidney impairment 1
• Ketosteril can help reduce the workload on the kidneys by providing essential amino acids and ketoanalogues, which can help prevent malnutrition and reduce nitrogen intake in CKD patients 1

It's worth noting that the provided evidence does not directly address the dosing of Ketosteril in CKD patients, but rather provides general information on the management of CKD and the use of various medications in this patient population. Therefore, the dosing recommendations provided are based on general clinical guidelines and may need to be adjusted based on individual patient needs and circumstances.

From the FDA Drug Label

Directions • shake bottle well before use • measure only with dosing cup provided • do not use dosing cup with other products • dose as follows or as directed by doctor adults and children 12 years of age and over 10 mL every 12 hours, not to exceed 20 mL in 24 hours children 6 to under 12 years of age 5 mL every 12 hours, not to exceed 10 mL in 24 hours children 4 to under 6 years of age 2.5 mL every 12 hours, not to exceed 5 mL in 24 hours children under 4 years of age do not use

The dosing instructions provided do not specifically address the dose of Ketosteril in patients with Chronic Kidney Disease (CKD). The dosing is based on age, and there is no mention of renal function or CKD. Therefore, the dose of Ketosteril in CKD cannot be determined from this information 2.

From the Research

Ketosteril Dose in CKD

• The dose of Ketosteril in patients with chronic kidney disease (CKD) varies depending on the study and the patient's weight.
• According to the study 3, the nutritional intervention consisted of a protein/calorie intake of 0.4-0.6 g/kg/day and 30-35 kcal/kg/day plus a tablet of ketoanalogues (Ketosteril®)/5 kg weight.
• The study 3 reported that the Ketosteril® intake was 11.87 tablets/day (range: 9-14).
• Another study 4 administered 6 tablets of Ketosteril per day to patients with CKD.
• The study 5 used a dose of 1 tablet of keto/amino acid ketosteril per 5 kg of body weight/day in combination with a low-protein diet.

Efficacy of Ketosteril in CKD

• The studies 3, 4, and 5 suggest that Ketosteril, in combination with a low-protein diet, can help preserve nutritional condition, improve glomerular filtration, and decrease urea levels in patients with CKD.
• The study 6 highlights the importance of essential amino acid and ketoacid mixtures, such as Ketosteril, in the conservative management of CKD, particularly in conjunction with a very low-protein diet.
• The study 5 found that the use of keto/amino acids, including Ketosteril, prevented malnutrition and mineral metabolic disturbances in patients with CKD.