Progression of chronic renal failure in patients given keto acids following amino acids

Twelve patients with chronic renal failure who exhibited a progressive decline in 24-h creatinine clearance despite being given, for 2-10 months, a diet containing 0.3 g of protein/kg ideal weight and 7-9 mg of phosphorus/kg ideal weight supplemented with vitamins, CaCO3, and 10 g per day of essential amino acids, were changed to a supplement containing predominantly keto acids. In 6 patients whose serum creatinine levels were 7.5 mg/dl or greater at changeover, progression continued unabated. In 6 patients with serum creatinine levels at changeover of 6.5-7.4 mg/dl, one was non-compliant with the diet and progressed to dialysis. In the other 5, progression, measured as the rate of change of a bimonthly radioisotope clearance, has been undetectable during the ensuing 1-2 years.