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Hungarian study of Low-Protein Diet
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National Center for Biotechnology Information (NCBI)
PubMed
Ls
NCBI.]
1: Wien Klin Wochenschr. 2001 Sep 17;113(17-18):688-94. Links
The effect of a keto acid supplement on the course of chronic
renal failure and nutritional parameters in predialysis patients and
patients on regular hemodialysis therapy: the Hungarian Ketosteril
Cohort Study.
* Zakar G;
* Hungarian Ketosteril Cohort Study.
St. Pantaleon Hospital, 2nd Medical Department, Eurocare 13th
Dialysis Center, Dunaujvaros, Hungary. gzakar.mis@mail.matav.hu
The results of the Hungarian Ketosteril follow up cohort study are
reported. Aim of the study was to evaluate the feasiblity and effects
of a low protein diet supplemented with keto acids/amino acids (KA) on
the progression of chronic renal failure (CRF) in a large group of
predialysis patients (PRE) and on nutritional parameters in both PRE
and dialysis patients (DIA). PATIENTS AND METHODS: PRE (N = 181) and
DIA (N = 42) patients treated in 47 hungarian nephrology and dialysis
centres were followed through 18 months. A standardized dietary and KA
supplementation protocol was prescribed (PRE group: KA 0.1 g/kgBW/day;
dietary protein 0.5-0.6 g/kgBW/day; energy 30 kcal/kgBW/day; DIA
group: dietary protein 1.2 g/kgBW/day, KA and energy prescription
similar to the PRE group). Progression of CRF was evaluated by linear
regression analysis of 1/serum Creatinine (sCr) values versus time,
subjective global assessment (SGA) scores were analyzed by Chi-square
test, other metabolic parameters (serum albumin, parathormone [iPTH],
Ca/P product) were analyzed by descriptive statistics. RESULTS: In PRE
patients slopes of 1/sCr were in the range of 0.0022-0.0015 [100 ml/mg
x month], showing no significant difference in the three subgroups of
PRE patients (Group A: initial serum creatinine (sCr) 201-400, Group
B: sCr 401-600, Group C: sCr > 600 mmol/L). Serum albumin levels below
35 g/L improved significantly, iPTH levels showed a tendency to
improve during KA supplementation. In dialysis patients there was an
improvement in SGA scores. Midweek predialysis blood urea and sCr
levels did not change significantly.
CONCLUSIONS: In a large group of PRE patients prescription of a low
protein diet supplemented with KA is feasible and leads to a
diminution of 1/sCr equation slopes independent from the degree of
renal dysfunction, suggesting a retardation in the rate of CRF
progression. There was an improvement in nutritional parameters both
in PRE and DIA patients, the latter being characterized by improved
SGA scores.
PMID: 11603104 [PubMed - indexed for MEDLINE
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| Now for what I saw in the text of this study.
The prescribed protein load of 0.6g/KG (60 mg/KG) in predialysis
patients is not what I would consider very low protein. In the old
days, the rule was 0.2 g/KG (20mg/KG). Now that is low protein. Also
in those times, they only increased the intake of protein to 0.4-0.5
g/KG (40-50 mg/KG) as tolerated after starting dialysis. By the way,
the normal protein intake of the average Adult male is in the range of
0.9-1.1 g/KG (90-110 mg/KG). and even less for Adult women. So the
point is that the diet they are advocating is only a 30-35% reduction in
normal protein intake. Not really low protein intake. In fact my
experience is that most late stage 3 Pre-ESRD patients can't tolerate
much more protein than this anyway without having digestive tract
distress. Reducing the intake of protein to this level will delay the
onset of the need for dialysis in some patients, but will do nothing in
others. It depends on comorbidities, as well as the specific disease
causing the failure. This is why it is best to follow the advice of
YOUR doctor, who knows, or should know, what is going on with you
personally. Remember, there are literally hundreds of different causes
for Kidney failure.
This does not, however, mean you can't get a second or even third
opinion from other Nephrologists. In fact, I strongly recommend it.
But I would recommend getting the second and/or third from a
Nephrologist with no connection to the Hospital or the doctors you
currently see. This is to prevent even the chance of a conflict of
interest. Also, don't allow the second or third to be based on tests
run by the prior Nephrologist . Insist on new testing.
Ultimately, the point here is that there is no magic bullet that will
guarentee a delay in dialysis. You will hear of patients who have all
of a sudden had dramatic increases in kidney function, even after
starting dialysis, but these are the exceptions, not the rule. Besides,
in the end they almost always end up on dialysis anyway, just down the
road. When something like this happens, and I have seen it twice in my
20 years personally, the person should count his belssings, live his
life to the best of his ability, but continue to monitor the situation
very intently, as the situation can turn around and go the other way
over night.
My best advice to the people on the board who are Pre-ESRD is to learn
as much as you can, if you think you have to try an alternative
treatment (of which I don't consider a very low protein diet one, just a
denial of facts), do so with the supervision of your Nephrologist. If
your Nephrologist refuses, as some may, find another. Just be very
aware to watch for changes that are negative, even mildly. Kidney
failure can occur suddenly.
Thanks for listening to my opinion on this subject
Dave
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| Jason Johnson 2006-10-13, 4:27 pm |
| In article <Xns985B485ABAA86Somebobysomeplacecom@66.150.105.230>, Dave
<Someboby@someplace.com> wrote:
Now for what I saw in the text of this study.
The prescribed protein load of 0.6g/KG (60 mg/KG) in predialysis
patients is not what I would consider very low protein. In the old
days, the rule was 0.2 g/KG (20mg/KG). Now that is low protein. Also
in those times, they only increased the intake of protein to 0.4-0.5
g/KG (40-50 mg/KG) as tolerated after starting dialysis. By the way,
the normal protein intake of the average Adult male is in the range of
0.9-1.1 g/KG (90-110 mg/KG). and even less for Adult women. So the
point is that the diet they are advocating is only a 30-35% reduction in
normal protein intake. Not really low protein intake. In fact my
experience is that most late stage 3 Pre-ESRD patients can't tolerate
much more protein than this anyway without having digestive tract
distress. Reducing the intake of protein to this level will delay the
onset of the need for dialysis in some patients, but will do nothing in
others. It depends on comorbidities, as well as the specific disease
causing the failure. This is why it is best to follow the advice of
YOUR doctor, who knows, or should know, what is going on with you
personally. Remember, there are literally hundreds of different causes
for Kidney failure.
This does not, however, mean you can't get a second or even third
opinion from other Nephrologists. In fact, I strongly recommend it.
But I would recommend getting the second and/or third from a
Nephrologist with no connection to the Hospital or the doctors you
currently see. This is to prevent even the chance of a conflict of
interest. Also, don't allow the second or third to be based on tests
run by the prior Nephrologist . Insist on new testing.
Ultimately, the point here is that there is no magic bullet that will
guarentee a delay in dialysis. You will hear of patients who have all
of a sudden had dramatic increases in kidney function, even after
starting dialysis, but these are the exceptions, not the rule. Besides,
in the end they almost always end up on dialysis anyway, just down the
road. When something like this happens, and I have seen it twice in my
20 years personally, the person should count his belssings, live his
life to the best of his ability, but continue to monitor the situation
very intently, as the situation can turn around and go the other way
over night.
My best advice to the people on the board who are Pre-ESRD is to learn
as much as you can, if you think you have to try an alternative
treatment (of which I don't consider a very low protein diet one, just a
denial of facts), do so with the supervision of your Nephrologist. If
your Nephrologist refuses, as some may, find another. Just be very
aware to watch for changes that are negative, even mildly. Kidney
failure can occur suddenly.
Thanks for listening to my opinion on this subject
Dave
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dave,
I agree with most of your comments. You probably believe that I want every
predialysis patient to be encouraged to go on a low protein diet. That is
not true.
If I was a nephrologist, this is what I would do:
If a patient was referred to me, I would arrange for the patient to have
every test that is normally conducted on predialysis patients.
I would examine those test results. If the tests (eg GPR 5 ml per min)
indicated that a person's life was in danger, I would arrange for the
patient to be placed on dialysis ASAP.
On the other hand, if another patient's test results indicated that it
would be several months before the patient needed to be placed on
dialysis, I would inform the patient about all of the treatment options
including the very-low-protein diet with a supplement of amino acids or
ketoacids.
I would monitor every patient that was on the very low protein diet.
We all have to take responsibility for our health and medical problems.
Believe it or not, we are on the same page.
The nephrologists that I have NO respect for are the ones that don't
inform their predialysis patients (that still have several months or more
before they would need to be placed on dialysis) about the very low
protein diet treatment program.
Thanks for your comments about the research report. I was not aware of
some of those issues that you mentioned in your post.
Jason
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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| In article <Xns985B485ABAA86Somebobysomeplacecom@66.150.105.230>,
Dave <Someboby@someplace.com> wrote:
> My best advice to the people on the board who are Pre-ESRD
Dave, in case you missed it - Jason is so pre-ESRD he doesn't even have
kidney disease. He's our groupie. (Lucky us.)
--
"Did Father shoot him? I will eat Grandfather for dinner."
- Helen Keller, on learning of the death of her grandfather
email: aripee at inanna . com
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| Jason Johnson 2006-10-14, 4:28 pm |
| In article <HPYXg.14540$e66.14427@newssvr13.news.prodigy.com>, REP
<rep~@inanna.com> wrote:
In article <Xns985B485ABAA86Somebobysomeplacecom@66.150.105.230>,
Dave <Someboby@someplace.com> wrote:
> My best advice to the people on the board who are Pre-ESRD
Dave, in case you missed it - Jason is so pre-ESRD he doesn't even have
kidney disease. He's our groupie. (Lucky us.)
~~~~~~~~~~~~~~~~~~~~~~
REP,
Good point. Thanks to Doctor Walser and the information that I read in
a book related to Renal Tubular Acidosis, I hope to
remain pre-ESRD for the rest of my life. I also learned a lot from
the posts of various people in this newsgroup including yourself.
You always do a great job of providing advice and hope that you
continue to do so.
In relation to spelling and grammar, that has always been a problem
for me due to my poor grade school and high school education. However,
it was good enough to get a Master's Degree. My major (as you have
probably guessed) was NOT english or a science related field.
I am now retired. I had to take an early retirement due to my
medical problems.
Jason
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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