The goal of this non-commercial clinical trial is to assess efficacy and safety of ketoanalogues of essential amino acids in the prevention of protein-energy wasting in nephrotic syndrome.
Adult patients with new diagnosis or relapse of nephrotic syndrome and glomerular filtration rate of ≥ 30 mL/min/1.73m2 will be included in the study. Exclusion criteria will be a secondary cause of nephrotic syndrome, morbid obesity and severe diseases affecting nutritional status. Participants will be randomly assigned to the intervention group (KA+MPD) or control group (MPD); randomization will be stratified by type of glomerular disease (podocytopathy or other type) and investigational site. The control group will follow the diet recommended in nephrotic syndrome - a medium protein diet (MPD) - under the care of a dietitian. Intervention group will receive Ketosteril (1 tablet for every 5 kg of ideal body weight) as an addition to the diet. All patients will also receive treatment for underlying glomerular disease in accordance with current guidelines and local practice. The main objective is to assess the efficacy of Ketosteril as an add-on therapy in preventing the loss of lean tissue mass (LTM) over 6 months compared to a standard diet. The additional aims include the assessment of muscle function parameters, nephrotic syndrome severity and laboratory indicators of catabolism.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
150
Daily dose = 1 tabl / 5 kg of ideal body weight
MPD: daily protein intake of 0.8-1.0 g/kg of ideal body weight + up to 5 g based on daily proteinuria
Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine - National Research Institute
Warsaw, Masovian District, Poland
RECRUITINGMaximum loss of lean tissue mass
The difference between the initial lean tissue mass (LTM) and the lowest LTM measured within 6 months, expressed in percentage. The non-inferiority hypothesis of Ketosteril use will be tested as the primary endpoint. LTM will be measured with bioimpedance spectroscopy.
Time frame: 6 months
Maximum loss of lean tissue mass
The difference between the initial lean tissue mass (LTM) and the lowest LTM measured within 6 months, expressed in percentage. The superiority hypothesis of Ketosteril use will be tested as the secondary endpoint.
Time frame: 6 months
Neph-PEW diagnosis
The percentage of patients meeting criteria of nephrotic syndrome-associated protein-energy wasting (neph-PEW): reduction of LTM by 3% within 3 months or by 5% within 6 months.
Time frame: 6 months
6-minute walk test distance
Change in distance walked in the 6-minute walk test from baseline value; expressed in meters.
Time frame: 6 months
Handgrip strength (HGS)
Change in HGS value from baseline; expressed in kg.
Time frame: 6 months
Serum albumin
Change in serum albumin level from baseline value; expressed in g/dL.
Time frame: 6 months
Urinary protein/creatinine ratio (uPCR)
Change in uPCR value from baseline; expressed in mg/g.
Time frame: 6 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Low density lipoprotein (LDL)
Change in serum LDL level from baseline; expressed in mg/dL.
Time frame: 6 months
Triglycerides
Change in serum triglycerides level from baseline; expressed in mg/dL.
Time frame: 6 months
Uric acid
Change in serum uric acid level from baseline; expressed in mg/dL.
Time frame: 6 months
Unfavorable disease course
The percentage of patients who experienced the unfavorable disease course including: glomerular disease related death; venous or arterial thromboembolic event; infection requiring hospital admission; acute kidney injury in the stage 2 or 3; sustained glomerular filtration rate reduction over 50% or initiation of kidney replacement therapy; unplanned hospital admission due to complications of nephrotic syndrome treatment.
Time frame: 12 months
Glomerular filtration rate
Change in glomerular filtration rate from baseline; expressed in mL/min/1.73m2.
Time frame: 12 months