In a new publication from Jothydev’s Diabetes Research Centre, authors have described the use of ketoanalogue supplementation in preventing the progression of kidney disease in diabetes patients. The clinical experience of using Ketoanalogue supplementation in patients with diabetic kidney disease on Very Low Protein Diet (VLPD) was brought out by Elsevier Publications in ‘Dietary Protein Restriction in Chronic Kidney Disease- Very Low–Protein Diet with Ketoanalogue Supplementation in Diabetic Kidney Disease’. The author Dr.Jothydev Kesavadev and team discuss 4 impressive clinical cases of patients on ketoanalogue. An analysis of the data of patients on ketoanalogue at Jothydev’s Diabetes Research Centre, Trivandrum also shows statistically significant improvement in creatinine and hemoglobin levels after administration of ketoanalogue.

Ketoanalogues are branched chain amino acids that do not contain nitrogen. When they enter the circulation, they derive the nitrogen from the tissues. Thus, less nitrogen or urea is to be formed. However, if enough nitrogen is available from the diet, these amino acids will not take up the tissue nitrogen and hence when patient is on ketoanalogue, dietary protein restriction should be strictly followed.

However, the main limitation of the case studies and experiences presented here from our centre is the fact that treatment in our center is based on Diabetes Tele Management System (DTMS®). In this telemedicine follow up program integrating technology with a multi-disciplinary diabetes team , patients are treated with a target fasting glucose, post prandial glucose, HbA1c, BP and LDL values customized to each patient based on multiple parameters. It is well proven that such intensive modalities can prevent the rapid progression of a renal disease. This could be a confounding factor in the experiences described in the use of ketoanalogue.