Information For Physicians
Click below to view 4 short videos presented by Dr. Elizabeth Sussman PhD RD, Associate Professor of Nutrition and Dietetics specializing in renal nutrition and research, reviewing clinical data on the use of low protein diets supplemented with keto-analogues as a tool to slow the progression of CKD and maintain nutrition.
- 90 doses per canister. 2.1g of Keto & Amino Acids per dose.
- A cost effective keto-analogue, available in the USA.
- To be used in conjunction with a low or very low protein diet.
- May be a tax deductible medical expense.
- Vanilla flavored drink mix.
- Made in the USA in an FDA inspected facility.
Low and very low protein diets supplemented with keto-analogues.
The use a low or very low protein diet supplemented with a keto-analogue is widely used for managing CKD in Europe, Asia and other parts of the world. Keto-analogue use has been limited in the United States because of its lack of availability.
The use of a low or very low protein diet supplemented with a keto-analogue has been shown to reduce CKD progression, slow the onset of uremic symptoms, and improve nutritional parameters and markers. Please see the section below titled: "Recent clinical Data on the use of keto-analogues with LPD/VLPD" for clinical references and further information.
Keto-analogues of essential amino acids provide potential advantages for CKD patients. The Keto-acids in a keto-analogue lack the amino group bound to the alpha carbon of an amino acid so they can be converted to their respective essential amino acids without providing additional nitrogen.
Ketorena is a keto-analogue of essential amino acids used in combination with a low or very low protein renal diet. The combination of the diet and the keto-analogue is designed to slow the progression of CKD and improve nutrition without kidney toxic nitrogenous waste.
Each dose of Ketorena contains 2100 mg or 2.1g of Keto & Amino Acids.
Ketorena and keto-analogues have no relation to ketogenic high fat, low carbohydrate weight loss diets.
The starting dose of Ketorena is 1 scoop 3 times daily when initiating a low protein diet. Maintenance dosing for Ketorena is individualized based on the level of protein restriction and patient body weight.
Please review the dosing and treatment protocol below from the IKABM. The dosing recommendations are to initiate a keto-analogue at 0.1g/kg BW/day.
A patient weighing 60kg would then take 0.1g x 60 = 6g or 6000mg. 1 scoop of Ketorena = 2100mg or 2.1g. 3 scoops = 6300mg or 6.3g. The dose would then be 1 scoop 3 times daily.
Patient types who may benefit from a low or very low protein diet supplemented with Ketorena:
- CKD patients with advanced disease who wish to delay dialysis.
- All CKD 4-5 patients.
- CKD 3 patients with a progressive decline in GFR.
- Patients with nephrotic syndrome who are being considered for a low protein diet.
- Post kidney transplant patients with CKD 3-5 or those with proteinuria.
- Dialysis patients (PD or incremental HD) with residual renal function.
The following beneficial effects may be found with a keto-analogue supplemented protein restricted diet:
- Slow the progression of CKD
- Improve mortality versus similar patients initiating dialysis.
- Delay the time until dialysis is required to treat uremic symptoms.
- Decrease levels of uremic toxins
- Reduce proteinuria
- Prevent malnutrition
- Improve calcium-phosphate metabolism/hyperparathyroidism
The International Keto Analogue Board Meeting (IKABM) consensus statement on the
use of low and very low protein diet supplemented with keto-analogues in CKD.
Recent clinical data on the use of keto-analogues with an LPD/VLPD
Click on link to access.
Ketoanalogues supplementation decreases dialysis and mortality risk in patients with anemic advanced chronic kidney disease. (Wu, Che-Hsiung et al. PLOS ONE May 5 2017)
Effect of restricted protein diet supplemented with keto analogues in chronic kidney disease: a systematic review and meta analysis. (Jiang, Zheng et al. Int Urol Nephrol 2016)
Adherence to ketoacids/essential amino acids-supplemented low protein diets and new indications for patients with chronic kidney disease (Fouque et al. BMC Nephrology 2016)
Keto Supplemented Low Protein Diet: A valid therapeutic approach for patients with steroid-resitant proteinuria during early-stage chronic kidney disease. (Zhang, J et al. J Nutr Health Aging 2016)
Very low protein diet plus ketoacids in chronic kidney disease and risk of death during end stage renal disease: a historical cohort controlled study. (Bellizzi, V et al. NDT (2015)30:71-77)
Nephrologist perspectives on the use of keto-analogues in CKD
Click on link to access.
Is there a role for Ketoacid Supplements in the Management of CKD? (A. Shah MD; et al: AJKD, Vol 65, May 2015)
Patient resources for finding renal dietitians specializing in low protein CKD diets.
Nephcentric has partnered with several Renal RDs specializing in counseling patients on low and very low protein diets. A list of these RDs and how patients can contact them can be found on the CKD Patients page of this site.
Converting to Ketorena from tableted keto-analogues.
A single scoop of Ketorena contains 2100 mg or 2.1g of keto/amino acids. Most, but not all tableted keto-analogues contain 600mg of keto/amino acids per tablet.
Ketorena can be taken 2-3 times per day depending on the converted dose.
A typical dose conversion may look like: 600mg tablets x 10 per day = 6000mg or 6g total daily dose
1 scoop of Ketorena: 2100 mg or 2.1g x 3 = 6300mg or 6.3g total daily dose or 1 scoop 3 times per day.
Frequently Asked Questions
A: Currently Ketorena is available to purchase directly from Nephcentric on this site or by calling 1-844-980-9933. A 90 serving canister of Ketorena costs $145.50. We offer a 30% discount when purchasing 2 or more canisters at once. This brings the cost down to $99.75 per canister. While this is expensive, other foreign sourced keto-analogues cost between $250-$450 per month.
A: Keto-analogues of essential amino acids provide potential advantages for CKD patients. Keto-acids lack the amino group bound to the alpha carbon of an amino acid so they can be converted to their respective essential amino acids without providing additional nitrogen.
A: A single dose of Ketorena easily mixes into solution with as little as 3-4 ounces of water or juice. Ketorena is available in natural vanilla flavor.
A: Ketorena is packaged as a drink mix powder with 60 doses in a canister. Other keto-analogues are in tablet form and often have pill burdens of 12-24 tablets per day for a 70kg adult. Ketorena is designed to reduce pill count. A single dose of Ketorena easily mixes with 3 ounces of water or juice.
A: Unlike supplement,s a medical food, as defined in section 5(b)(3) of the Orphan Drug Act (21 U.S.C. 360ee(b)(3)), is “a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.” Medical Foods, including Ketorena can be purchased OTC without a prescription. Ketorena is made in the USA in an FDA inspected facility under cGMP guidelines.
A: The FDA classifies Ketorena as GRAS or Generally Recognized As Safe. This is a designation that ingredients added to food is considered safe by experts, and so is exempted from the usual Federal Food, Drug and Cosmetic Act (FFDCA) food additive tolerance requirements.