title: Very low protein diets supplemented with keto-analogues in ESRD predialysis patients and its effect on vascular stiffness and AVF Maturation.
abstract: Native arteriovenous fistula (AVF) is the most appropriate type of vascular access for chronic dialysis. Its patency rates depend on vascular wall characteristics. Ketoacid analogues of essential amino acids (KA/EAA) are prescribed in end-stage renal disease (ESRD) pre-dialysis patients to lower toxic metabolic products generation and improve nutritional status. We hypothesized that very-low protein diet (VLPD) supplemented with KA/EAA may influence arterial wall stiffness and affect AVF maturation rates and duration in pre-dialysis ESRD patients.
  
  
  
  In a prospective, cohort, 3 years study we enrolled 67 consecutive non-diabetic early referral ESRD patients that underwent AVF creation in our hospital. Patients were divided in two groups based on their regimen 12 months prior to surgery: a VLPD supplemented with KA/EAA study group versus a low protein diet non-KA/EAA-supplemented control group. For each patient we performed serum analysis for the parameters of bone mineral disease, inflammation and nutritional status, one pulse wave velocity (PWV) measurement and one Doppler ultrasound (US) determination prior the surgery, followed by consequent Doppler US assessments at 4, 6, 8 and 12 weeks after it. Rates and duration of mature AVF achievement were noted. We used logistic regression to analyze the association between AVF maturation and KA/EAA administration, by comparing rates and durations between groups, unadjusted and adjusted for systolic blood pressure, C-reactive protein, PWV, phosphorus values. All parameters in the logistic model were transformed in binary variables. A p-value < α = 0.05 was considered significant; data were processed using SPSS 16 software and Excel.
  
  
  
  In the study group (n = 28, aged 57 ± 12.35, 13 females) we registered better serum phosphate (p = 0.022) and C-reactive protein control (p = 0.021), lower PWV (p = 0.007) and a higher percent of AVF creation success (33.3 % versus 17.8 %, p < 0.05). AVF maturation duration was lower in study group (5.91 versus 7.15 weeks, p < 0.001).
  
  
  
  VLPD supplemented with KA/EAA appear to improve the native AVF primary outcome, decreasing the initial vascular stiffness, possible by preserving vascular wall quality in CKD patients through a better serum phosphate levels control and the limitation of inflammatory response.
authors.affiliation: Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, 37th Dionisie Lupu Street, 020021, Sector 2, Bucharest, Romania.|Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital Bucharest, Bucharest, Romania.
authors.forename: Cristiana
authors.initials: C
authors.lastname: David
authors.affiliation: Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, 37th Dionisie Lupu Street, 020021, Sector 2, Bucharest, Romania. ileana_peride@yahoo.com.|Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital Bucharest, Bucharest, Romania. ileana_peride@yahoo.com.
authors.forename: Ileana
authors.identifier: 0000-0002-4912-6590
authors.initials: I
authors.lastname: Peride
authors.affiliation: Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, 37th Dionisie Lupu Street, 020021, Sector 2, Bucharest, Romania.|Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital Bucharest, Bucharest, Romania.
authors.forename: Andrei
authors.initials: A
authors.lastname: Niculae
authors.affiliation: Bucharest University of Economic Studies, Bucharest, Romania.
authors.forename: Alexandra Maria
authors.initials: AM
authors.lastname: Constantin
authors.affiliation: Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, 37th Dionisie Lupu Street, 020021, Sector 2, Bucharest, Romania.|Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital Bucharest, Bucharest, Romania.
authors.forename: Ionel Alexandru
authors.initials: IA
authors.lastname: Checherita
mesh_terms: D000328:Adult; D000368:Aged; D000601:Amino Acids, Essential / Q000008:administration & dosage*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D018753:Diet, Protein-Restricted / Q000379:methods; D005260:Female; D006801:Humans; D007651:Keto Acids / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects / Q000502:physiology*
chemical_list: D000601:Amino Acids, Essential; D007651:Keto Acids; D002097:C-Reactive Protein
keywords: Arterial stiffness; Arteriovenous fistula maturation; End-stage renal disease; Ketoacid analogues of essential amino acids