title: Effects of a low-protein, low-phosphorus diet on metabolic insulin clearance in patients with chronic renal failure.
abstract: The metabolic clearance rate (MCR) of insulin was studied in 17 nondiabetic patients with advanced chronic renal failure (creatinine 479 +/- 15 mumol/L, glomerular filtration rate 14.6 +/- 2.9 mL/min) before and after 3 mo of a low-protein, low-phosphorus diet (LPD) providing daily per kilogram 0.3 protein of vegetal origin and 3-5 mg inorganic phosphorus. The energy supply (146 kJ.kg-1 x d-1) was furnished mainly by carbohydrates. The diet was supplemented with a mixture of essential amino acids and keto-analogues. The MCR of insulin was determined by using the euglycemic clamp technique. Before the diet the MCR of insulin was low (450 +/- 127 mL.min-1 x m-2) but increased significantly at the third month (568.8 +/- 148 mL.min-1 x m-2), reaching values close to the MCR of control subjects (630 +/- 135 mL.min-1 x m-2). Identical results have been described during hemodialysis of anephric patients, leading us to hypothesize that an LPD reduces the production of dialyzable factors that interfere with peripheral insulin metabolism.
authors.affiliation: Clinique Médicale and Clinique Néphrologique, Université de Bordeaux II, Hôpital Pellegrin Tripode, France.
authors.forename: H
authors.initials: H
authors.lastname: Gin
authors.forename: C
authors.initials: C
authors.lastname: Combe
authors.forename: V
authors.initials: V
authors.lastname: Rigalleau
authors.forename: C
authors.initials: C
authors.lastname: Delafaye
authors.forename: M
authors.initials: M
authors.lastname: Aparicio
authors.forename: J
authors.initials: J
authors.lastname: Aubertin
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D004032:Diet; D004044:Dietary Proteins; D005260:Female; D005919:Glomerular Filtration Rate; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000493:pharmacokinetics*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010758:Phosphorus; D014508:Urea / Q000097:blood / Q000652:urine
chemical_list: D004044:Dietary Proteins; D007328:Insulin; D010758:Phosphorus; D014508:Urea; D003404:Creatinine