Prevention of prednisone-induced negative nitrogen balance. Effect of dietary modification on urea generation rate in patients on hemodialysis receiving high-dose glucocorticoids.
To assess whether increasing dietary protein and calorie intake can ameliorate the negative nitrogen balance induced by 70 to 120 mg/d prednisone, we studied nitrogen intake and net urea generation rate in patients undergoing hemodialysis for 10 to 14 days after renal transplantation. Seven patients receiving prednisone with moderately restricted protein (0.73 +/- 0.03 g/kg of body weight per day) and calorie (20 +/- 4 kcal/kg of body weight per day) intake had high urea nitrogen generation rates (199 +/- 18 mg/kg.d) and protein catabolic rates (1.45 +/- 0.12 g/kg.d) and were in marked negative protein balance (-0.72 +/- 0.12 g/kg.d). An increase in protein (1.30 +/- 0.06 g/kg.d) and calorie (33 +/- 3 kcal/kg.d) consumption in another eight prednisone-treated patients resulted in protein balance (-0.02 +/- 0.12 g/kg.d) without further increasing urea generation (174 +/- 9 mg/kg.d). Six control patients undergoing hemodialysis after surgery who were not receiving prednisone had lower urea generation rates (109 +/- 15 mg/kg.d) and were in nitrogen balance. Nitrogen wasting is therefore not an inevitable consequence of high-dose glucocorticoid therapy and can be effectively prevented by simple nutritional modification without increasing hemodialytic requirements.
D000328:Adult; D004035:Diet Therapy; D004044:Dietary Proteins; D002149:Energy Intake; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D009584:Nitrogen / Q000378:metabolism*; D011241:Prednisone / Q000009:adverse effects*; D011446:Prospective Studies; D006435:Renal Dialysis; D014508:Urea / Q000096:biosynthesis
D004044:Dietary Proteins; D005938:Glucocorticoids; D014508:Urea; D009584:Nitrogen; D011241:Prednisone