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Low Protein Diet in CKD

Low protein and very low protein diets have been clinically shown to delay the progression of CKD, help retain kidney function, and delay the need for dialysis. This has also been shown even when kidney disease is in an advanced stage.

Clinical studies in people with very advanced CKD who wish to initiate a very low protein diet plus a keto-analogue, may be able to postpone dialysis by years. When the studies have compared the rate of death and hospitalization in patients who initiated a very low protein diet supplemented with a keto-analogue, versus similar people who started dialysis, the people who initiated the very low protein diet plus a keto-analogue lived longer and were hospitalized less than the people who started dialysis.

When protein is metabolized, part of the metabolism process creates waste products that can increase the level of nitrogen and acid in your body. The kidneys have to work harder to remove these waste products. This extra work can tax the already compromised kidneys, accelerating the rate of kidney function decline and the need for dialysis.

Elevated acid levels themselves can have a direct effect on the decline of kidney disease as well. More information on managing elevated serum acid levels due to CKD can be found at www.bicarbi.com.

One concern with low and very low protein diets is that they can lead to malnutrition and reduced muscle strength because of the reduction in protein intake. Your Health Care Provider may call this type of malnutrition Protein Energy Wasting.

In order to reduce the possibility of Protein Energy Wasting from happening, a scientifically formulated blend of amino acids called keto-forms of amino acids have been used with good success. Ketorena is a keto-form of amino acids blend also called a keto-analogue. Keto-analogues are designed to provide the needed protein for proper nutrition without the metabolites found in protein (especially animal protein) that can be harmful to the kidney.

The nutritional strategy of pairing a low or very low protein diet supplemented with a keto-analogue is designed to provide the needed protein for healthy living without the kidney damaging protein metabolites.

Clinical guidelines and consensus statements by leading kidney doctors recommend a low or very low protein diet treatment strategy for reducing the progression of kidney disease and as a means to avoid or delay dialysis. A low or very low protein diet may need to be supplemented with a keto-analogue.

Keto-analogues have not been widely available in the USA until now.

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About Ketorena

Ketorena is a keto-analogue of essential amino acids. Ketorena taken in combination with a low or very low protein diet, is designed to slow the progression of Chronic Kidney Disease (CKD), avoid or delay the need for dialysis and improve nutrition for physical health and well being.

The essential amino acids in Ketorena are designed to provide needed protein for health and well being without the production of nitrogenous waste products harmful to the kidney.

Ketorena is designed for safety without magnesium, which has risk of accumulating in people with CKD if taken in high doses. Ketorena is also a drink powder taken 2-3 times per day. No pills to swallow.

Each dose of Ketorena contains 2.1g of Keto & Amino Acids.

Ketorena has no relation to ketogenic diets. Ketorena is a keto-analogue of essential amino acids specifically designed to be used with a low or very low protein kidney diet. Ketorena in combination with a low protein diet, is designed to slow the progression of CKD with the goal of avoiding dialysis, extending lifespan and improving the quality of life.

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Ketorena Dosing

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 body weight.

Please review the dosing and treatment protocol in the Physicians section from the IKABM consensus statement. The dosing recommendations are to initiate a keto-analogue at 0.1g/kg BW/day.

Under these recommendations, a person 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.

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People who may benefit from a low or very low protein diet supplemented with Ketorena:

• Those with advanced disease who wish to find an alternative to dialysis.
• Those with CKD stages 4-5.
• Those with CKD stage 3 with a progressive decline in GFR.
• Those with nephrotic syndrome who are being considered for a low protein diet.
• Those who are post transplant with CKD 3-5 or those with proteinuria.
• People on dialysis (PD or incremental HD) with residual renal function.

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Initiating a low protein diet supplemented with Ketorena: The team approach

Ketorena is a medical food and should be used under the care of a qualified Health Care Practitioner. Working with both your kidney Doctor as well as a Renal Dietitian may be the best way to achieve success initiating and maintaining a low protein diet to slow the progression of CKD.

Renal Dietitians are professionally trained dietitians who specialize in the nutritional needs of people with kidney disease.

Your Kidney Doctor will monitor your lab values and overall progress while collaborating with your Renal Dietitian to make any needed alterations in diet, meal planning or Ketorena dose.

If your doctor doesn't have a consulting renal dietitian, the following dietary professionals and organizations offer low protein dietary consultation and guidance:

• Jessianna Saville, MS, RDN, Renal Dietitian and Dietary Consultant. You can reach Jessiana and her team of consultant Renal Dietitians at www.kidneyrd.com.
• Jessica Prohn, MS, RD, Renal Dietitian and Dietary Consultant. You can reach Jessica at kidneyrd.com/jessica-prohn
• Kay Head, RD, LD Renal Dietitian and Dietary Consultant. YOu can reach Kay at kidneyrd.com/kay-head
• Jennifer Moore, MS, RDN, Renal Dietitian and the Author of 'Plant-Fed Kidneys'. You can reach Jennifer at plantfedkidneys@gmail.com
• Kristi Edwards, MS, RDN, Renal Dietitian and Co-founder of 901 Nutrition. You can reach Kristi at 901kristi@gmail.com
• The Council on Renal Nutrition*, an organization of professional renal dietitians who work with kidney patients can be found by clicking HERE. The Council on Renal Nutrition offers both local and virtual services to kidney patients and many are able to bill your insurance.

*please note that the link to the Council on Renal nutrition is used under their permission but is not an endorsement of Ketorena, any dietary counseling needs to be determined by a patients physician and dietitian.

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Converting to Ketorena from tableted keto-analogues.

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Frequently Asked Questions

Q: Where do I purchase Ketorena?

A: Currently Ketorena is available to purchase directly from us on this site or by calling 1-844-980-9933. A 90 serving canister of Ketorena costs $145.50. We offer a 30% discount and free shipping for purchases of 2 or more canisters, which brings the price down to $99.75 per canister. While this is expensive, other foreign sourced keto-analogues cost between $250-$450 per month.

Medical Foods like Ketorena, when recommended by a Health Care Provider, are often a qualified tax deductible medical expense.

Medical Foods like Ketorena may also be purchased under a Health Saving Account (HSA). More information can be found by Clicking HERE to read the IRS guidance on this.

Q: How much protein is in a low or very low protein diet?

A: The definition of low and very low protein diets for those with CKD vary, but generally most health care providers consider a low protein diet to consist of 0.6g protein/Kg of body weight/day. A very low protein diet typically consists of 0.3g protein/Kg of body weight/day. The US RDA recommends 0.8g protein/Kg body weight/day for those without CKD. The typical American diet is high in protein and consists of 1.0g or more of protein/Kg body weight/day.

For someone weighing 150 lbs (68 kg), the daily protein intake for a low protein diet would be 0.6g x 68 = 40.8g

For someone weighing 150lbs (68 kg), the daily protein intake for a very low protein diet would be 0.3g x 68 = 20.4g

Q: What is a Medical Food?

A: Unlike supplements, Medical Foods are regulated under the FDA Orphan Drug Act. They are for the management of specific diseases and are used and dosed under the supervision of a health care provider.