Effects of severe protein restriction with ketoanalogues in advanced renal failure.
OBJECTIVE
To compare a severe protein restriction diet supplemented with ketoanalogues to a moderate protein restriction diet in order to limit glomerular filtration rate (GFR) decrease in an advanced renal insufficiency stage.


METHODS
Prospective randomised study conducted to compare a severe protein restriction diet (0.30 g/kg/day) supplemented with a preparation of ketoanalogues, hydroxyanalogues of aminoacids and aminoacids (Group A) to a moderate protein restriction diet (0.65 g/kg/day) (Group B).


METHODS
50 uremic patients included (25 in each group) with GFR is <20 mL/min/1.73m2.


RESULTS
There were no statistically significant differences between the two dietary regimens for the renal survival. But uremia decreased significantly in Group A (22.7+/-5.2 to 18.5+/-6.7 mmol/L) and increased in Group B (26.8+/-9.0 to 34.9+/-9.9 mmol/L). Calcemia increased in Group A from 2.28+/-0.18 to 2.42+/-0.17 mmol/L, p<0.01 with a stable phosphoremia while calcemia decreased in Group B (2.33+/-0.18 to 2.25+/-0.17 mmol/L, p<0.05). At the end of the study, Group A was different from Group B for calcemia (2.42+/-0.17 vs. 2.25+/-0.17 mmol/L, p<0.01), phosphoremia (1.39+/-0.30 vs. 1.80+/-0.65 mmol/L, p<0.02), alkaline phosphatase (61.42+/-22.93 vs. 78.8+/-27.0, p<0.05) and parathormone plasma levels (2.71+/-1.55 vs. 5.91+/-1.41 ng/mL, p<0.001).


CONCLUSIONS
Compared to a moderate protein restriction (0.65 g/kg/day), a severe protein restriction (0.3 g/kg/day) supplemented by ketoanologues does not limit GFR decrease when GFR is below 20 mL/min/1.73m2, but improves phosphocalcic plasma parameters.
Malvy
D
D
Centre René Labusquière and INSERM U.330, Université Victor Segalen Bordeaux 2, France.
Maingourd
C
C
Pengloan
J
J
Bagros
P
P
Nivet
H
H
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000008:administration & dosage; D000601:Amino Acids, Essential / Q000008:administration & dosage*; D002118:Calcium / Q000097:blood; D018753:Diet, Protein-Restricted; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000178:diet therapy* / Q000503:physiopathology; D014511:Uremia / Q000178:diet therapy
D000596:Amino Acids; D000601:Amino Acids, Essential; D010281:Parathyroid Hormone; D010758:Phosphorus; C048995:ketosteril; D000469:Alkaline Phosphatase; D002118:Calcium