Effects of low-protein diet supplemented with ketoacids and erythropoietin in chronic renal failure: a long-term metabolic study.
Ketoacids (KA) and recombinant human erythropoietin (rHuEPO) may each, on their own, influence the metabolic status of patients with chronic renal failure (CRF). A long-term prospective randomized study was designed to monitor the metabolic and nutritional status and progression of CRF using three therapeutic protocols: (A) low-protein diet (LPD) with 0.6 g of protein and 35 kcal/kg/day, with recombinant human erythropoietin (rHuEPO) at a dose of 40 U kg/week and keto acids (KA) 100 mg/kg/day, (Group I), (B) LPD and rHuEPO (Group II), and (C) LPD only (Group III). A total of 105 patients (50M/55F), aged 26-78 years, CCr 22-36 ml/min, were monitored at the beginning, and at every 6 months for 3 years in the above three study groups. Group I comprised 35 patients, Group II 38 patients and Group III 32 patients. During follow-up, a significantly smaller decrease in GFR (CCr, Cin) and in I/SCr, and an increase in serum albumin, transferrin, leucine, body mass, index and HDL-cholesterol were found in Group I (all p < 0.01). In addition, significant decreases were also seen in proteinuria, renal fractional leucine excretion and serum triglycerides level (p < 0.01). Co-administration of LPD, rHuEPO and KA thus constitutes an effective alternative to conservative management of CRF, delaying in follow-up period progression of renal failure and correction of metabolic parameters.
Teplan
V
V
Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine and Chain of Nephrology, Postgraduate Medical School, Prague, Czech Republic. vladimir.teplan@medicon.cz
Schück
O
O
Knotek
A
A
Hajný
J
J
Horácková
M
M
Skibová
J
J
Malý
J
J
D000328:Adult; D000368:Aged; D000601:Amino Acids, Essential / Q000008:administration & dosage*; D018753:Diet, Protein-Restricted; D019587:Dietary Supplements; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007651:Keto Acids / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000178:diet therapy* / Q000188:drug therapy; D007930:Leucine / Q000097:blood; D008297:Male; D008875:Middle Aged; D011507:Proteinuria; D011994:Recombinant Proteins; D012709:Serum Albumin / Q000378:metabolism; D014168:Transferrin / Q000378:metabolism; D014280:Triglycerides / Q000097:blood
D000601:Amino Acids, Essential; D007651:Keto Acids; D011994:Recombinant Proteins; D012709:Serum Albumin; D014168:Transferrin; D014280:Triglycerides; D004921:Erythropoietin; C048995:ketosteril; D007930:Leucine