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Changes in serum calcium caused by supplementation of low protein diets with keto-acid analogues in patients with chronic renal failure.

Six patients with stable end stage chronic renal failure have been studied while receiving keto-acid supplements that provided a daily calcium load of 42 +/- 2 mM. None of the patients had intercurrent illness. All patients showed elevated serum calcium concentration levels while on keto-acid supplements, reaching significance on 5 occasions. Reciprocal falls in serum phosphate concentrations were noted in all patients, and this observation was not due to an anabolic effect of the keto-acids. In 3 patients, the rise in serum calcium concentration was associated with marked clinical manifestations that required curtailment of treatment. The risk of hypercalcemia occurs early and certain high risk categories can be identified. Recommendations about the use of calcium salts of alpha-keto-acid analogues are given and it is suggested that a choice should be made available between calcium and sodium salt analogues.