Reduction of morbidity related to emergency access to dialysis with very low protein diet supplemented with ketoacids (VLPD+KA).

OBJECTIVE: To delay the beginning of the renal replacement therapy (RRT) until the AV fistula is either made and mature or the training for peritoneal dialysis (PD) is given. DESIGN: Prospective study. SETTING: Nephrology's Ambulatory, Hospital Servidor Publico Estadual. PATIENTS: 21 patients with chronic kidney disease (CKD) have been followed. METHODS: For a period of 30 days, a VLPD+KA would be prescribed until the AV fistula was made or the PD training was given The patients were evaluated prior to the beginning of the VLPD+KA, on the 15th and the 30th day, and at the end of the study, with physical and nutritional evaluation, laboratory tests and 24-hour excretion of urinary urea and urinary protein, creatinine and urea residual clearance. RESULTS: 47.6% (10/21) of the patients have initiated HD with matured and suitable AV fistula made in 30 days; 33.3% (7/21) of the patients have been unfit to initiate RRT, even though with sufficient time for the creation of the AV fistula or the training for PD due to AV fistula thrombosis; 14.3% (3/21) of the patients have remained in the study with no need for dialysis, and 4.8% (1/21) have been excluded on the grounds of not having adhered to the VLPD+KA. The anthropometric parameters and the energy intake have not differed from one period to the other. CONCLUSION: The VLPD+KA is safe to maintain the nutritional status of patients of CKD until the AV fistula is made or the PD training is given.