Usage
- Alpha Ketoanalogue is prescribed for the dietary management of chronic kidney disease (CKD), particularly in patients with a glomerular filtration rate (GFR) less than 25 mL/min, in conjunction with a protein-restricted diet (typically 40g/day for adults). It is also used to slow the progression of kidney failure in diabetic nephropathy.
- Pharmacological Classification: Nutritional supplement.
- Mechanism of Action: Alpha ketoanalogues are nitrogen-free analogues of essential amino acids. In CKD, the body has difficulty processing nitrogen from protein. These ketoanalogues are metabolized into essential amino acids without adding to the nitrogen load, thereby reducing the buildup of uremic toxins and preserving kidney function while also preventing muscle wasting due to protein restriction.
Alternate Names
- Ketoanalogues, keto acid analogues.
- Brand names include Ketorena, Ketrenal, Alfa Add, Alpha Crez, Eulog, Ketocheck, Nefrogem Keto, NephroRick, RenalKet, Renolog, Renolog DS.
How It Works
- Pharmacodynamics: Alpha ketoanalogues reduce nitrogen load, decrease urea levels, help to maintain nutritional balance in patients with CKD and slow down the progression of the disease.
- Pharmacokinetics: Alpha ketoanalogues are absorbed rapidly in the gastrointestinal tract. They undergo transamination in the liver, where they are converted into their corresponding essential amino acids. The elimination pathways have not been specifically studied, but they are believed to follow the same catabolic pathways as the naturally occurring amino acids.
- Mode of Action: Alpha ketoanalogues are transaminated to the corresponding essential amino acids, using nitrogen from non-essential amino acids, thus reducing the nitrogen load on the kidneys.
- Receptor binding, enzyme inhibition, or neurotransmitter modulation do not appear to be involved in the mode of action.
- Elimination pathways are believed to be the same as their corresponding essential amino acids but are not well-characterized.
Dosage
Standard Dosage
Adults:
- 4-8 tablets three times daily with meals (for a 70 kg adult). This equates to approximately 1 tablet/5 kg body weight/day.
Children:
- There is no established dosing for children.
Special Cases:
- Elderly Patients: Dose adjustments may be needed based on renal function.
- Patients with Renal Impairment: Dose is based on GFR and protein intake restrictions.
- Patients with Hepatic Dysfunction: Caution is advised; dosage adjustments may be necessary.
- Patients with Comorbid Conditions: Individualized dosing based on overall clinical picture is recommended.
Clinical Use Cases
Dosage adjustments are based on renal function and protein intake restrictions rather than specific clinical settings such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
- Adjust dosage based on GFR, protein intake, and serum calcium levels.
- Consider modifying dosage in patients with renal or hepatic dysfunction.
Side Effects
Common Side Effects
- Hypercalcemia
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain/discomfort
- Metallic taste
Rare but Serious Side Effects
- Allergic reactions (skin rash, itching)
Long-Term Effects
- No specific long-term effects have been identified, but regular monitoring of serum calcium and other kidney parameters is recommended.
Adverse Drug Reactions (ADR)
- Hypercalcemia requiring dose reduction and/or reduction of dietary calcium and Vitamin D.
Contraindications
- Hypercalcemia
- Disturbed amino acid metabolism
- Hypersensitivity to any component of the drug
- Hereditary phenylketonuria (due to phenylalanine content)
Drug Interactions
- Calcium-containing drugs may increase serum calcium levels.
- Drugs forming insoluble compounds with calcium (tetracyclines, quinolones like ciprofloxacin and norfloxacin, iron-, fluoride-, or estramustine-containing drugs) should be avoided.
- Aluminum hydroxide-containing antacids should be avoided.
- Alcohol should be avoided due to the potential for unpleasant side effects.
Pregnancy and Breastfeeding
- Safety and efficacy in pregnant and breastfeeding women have not been established. Use only if clearly needed and benefits outweigh risks.
Drug Profile Summary
- Mechanism of Action: Provides essential amino acids in a nitrogen-free form, reducing the nitrogen load on the kidneys.
- Side Effects: Hypercalcemia, nausea, vomiting, diarrhea, abdominal discomfort.
- Contraindications: Hypercalcemia, disturbed amino acid metabolism, hypersensitivity.
- Drug Interactions: Calcium supplements, tetracyclines, quinolones, iron, fluoride, estramustine, aluminum hydroxide.
- Pregnancy & Breastfeeding: Safety not established.
- Dosage: 4-8 tablets three times daily with meals for adults (70 kg body weight).
- Monitoring Parameters: Serum calcium, phosphate, and other kidney function tests.
Popular Combinations
- Often used in combination with a low-protein diet and vitamin D supplements (with careful monitoring of calcium levels).
Precautions
- General Precautions: Monitor serum calcium, phosphate, and renal function. Ensure adequate calorie intake.
- Specific Populations: Use with caution in pregnant or breastfeeding women, children, and the elderly.
- Lifestyle Considerations: Avoid alcohol.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Alpha Ketoanalogue?
A: For adults (70kg), 4-8 tablets three times daily with meals. Dosage is adjusted based on body weight (approximately 1 tablet/5kg body weight/day) and should be individualized based on renal function and dietary protein intake.
Q2: What are the common side effects?
A: Hypercalcemia, nausea, vomiting, diarrhea, abdominal discomfort, and metallic taste.
Q3: Who should not take Alpha Ketoanalogue?
A: Patients with hypercalcemia, disturbed amino acid metabolism, or hypersensitivity to any component of the drug. Patients with hereditary phenylketonuria should also avoid this drug.
Q4: What are the significant drug interactions?
A: Calcium supplements, drugs forming insoluble complexes with calcium (e.g., tetracyclines, quinolones), iron, fluoride, estramustine, and aluminum hydroxide. Alcohol should be avoided.
Q5: How does Alpha Ketoanalogue work?
A: It provides essential amino acids without adding to the nitrogen load on the kidneys, thereby reducing the buildup of uremic toxins.
Q6: Can Alpha Ketoanalogue be used during pregnancy or breastfeeding?
A: Safety and efficacy have not been established. Use only if the benefits outweigh the risks.
Q7: What is the importance of a protein-restricted diet when using Alpha Ketoanalogue?
A: A protein-restricted diet is crucial to minimize nitrogenous waste buildup, maximizing the therapeutic benefit of Alpha Ketoanalogue.
Q8: How long should Alpha Ketoanalogue treatment continue?
A: Treatment is usually continued as long as GFR is below 25 ml/min and the patient is on a protein-restricted diet.
Q9: What monitoring is required for patients on Alpha Ketoanalogue?
A: Regular monitoring of serum calcium, phosphate, and other renal function parameters is recommended.
Q10: Are there any special considerations for elderly patients?
A: Dose adjustments may be required based on renal function in elderly patients.
