Vnitr Lek 2025, 71(7):432-440 | DOI: 10.36290/vnl.2025.079

Dual effect of keto amino acids and SGLT2 receptor inhibitors in seniors with chronic kidney disease: three years clinical monitoring

Vladimír Teplan^{1, 2, 3, 4}, Naděžda Petejová^{1, 2}, Ivo Valkovský^{1, 2}

¹ Interní a kardiologická klinika, Fakultní nemocnice Ostrava a Lékařská fakulta Ostravské univerzity, Ostrava

² Katedra interních oborů, Lékařská fakulta Ostravské univerzity

³ Subkatedra nefrologie, Institut postgraduálního vzdělávání ve zdravotnictví, Praha

⁴ Codum, s. r. o., Praha

In last decades, there is growing number of seniors over 65 years with chronic kidney disease (CKD). Beside of development in technology of dialysis and kidney transplantation there is a lot of patients who are not indicated for succefull management in dialysis - transplantation programme due to serious other organ damages. In our previous studies we have confirmed long-term effectivity of conservative management of CKD 3b-4 on modified low-protein diet (LPD) supplemented with keto amino acids (KA) in old patients over 80 years. In last decade, there were published very important studies supporting protective effect of SGLT2 receptor inhibitors (dapagliflozin and empagliflozin) in CKD pacients, in diabetics as well as in patients with cardiorenal syndrome (renal demage in chronic cardial failure). New modification in conservative management is LDP with keto amino acids and SGLT2 receptor inhibitors simultaneously in long-term follow up. Randomised prospective metabolic balance study comprises for a period of 36 months 42 patients in age group of 65-80 years with CKD 3b-4 on long-term low-protein diet of 0.8 g/BW/day (LP diet) supplemented with keto amino acids in a dose of 100 mg/kg BW/day. At the same time, 22 patiens were on medication of 10 mg of SGLT2 receptor inhibitor). Control group consisted of 20 patients in CKD 3b-4 on the same low-protein diet with keto amino acids only (standart management). There we no significant difference in GFR and measuresed biochemical parameters in Group I and Group II at the start of the study. At the end of the study we confirmed in Group I significant decrease of proteinuria and ACR (Gr Ia vs. Gr Ib, p < 0.025), as well as decrease compared to control Group II (Gr IIa vs. IIb p < 0.05). We found also better parameters in nitrogen metabolism (S urea,Gr Ia vs. Ib and IIa vs. IIb, p < 0.05) and in protein metabolism (S transferin, Gr Ia vs. Ib, p < 0.05). In Group I we confirmed correction of fasting glycaemia, as well as of total cholesterol, LDL-cholesterol and triglycerides (p < 0.05). In Group I (Gr Ia vs Ib) significantly decreased systolic (p < 0.025) and diastolic (p < 0.05)) blood pressure (p < 0.025) and values of NT-proBNT (Gr Ia vs. Ib) also significantly decreased (p < 0.02). Values of GFR during the follow up stay stable, compliance was very good and adherence to the diet exeeded 80 %. Dual effect of keto amino acids and SGLT2 receptor inhibitors was safe and long term effective with LP diet and offers new alternative for conservative management in risk CKD 3b-4 old patients with diabetes and cardiorenal syndrome.

Keywords: chronic renal insufficiency, SGLT2 receptor inhibitors, keto amino acids, metabolic study, seniors.

Accepted: October 16, 2025; Published: October 31, 2025  Show citation