| Jason Johnson 2006-10-13, 2:29 am |
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1: Wien Klin Wochenschr. 2001 Sep 17;113(17-18):661-9. Links
Metabolic effects of keto acid--amino acid supplementation in patients
with chronic renal insufficiency receiving a low-protein diet and
recombinant human erythropoietin--a randomized controlled trial.
* Teplan V,
* Schuck O,
* Votruba M,
* Poledne R,
* Kazdova L,
* Skibova J,
* Maly J.
Department of Nephrology, Institute for Clinical and Experimental
Medicine, Postgraduate Medical School, Prague, Czech Republic.
vladimir.teplan@medicon.cz
Supplement with keto acids/amino acids (KA) and erythropoietin can
independently improve the metabolic sequels of chronic renal
insufficiency. Our study was designed to establish whether a
supplementation with keto acids/amino acids (KA) exerts additional
beneficial metabolic effects in patients with chronic renal insufficiency
(CRF) treated with a low-protein diet (LPD) and recombinant human
erythropoietin (EPO). In a prospective randomized controlled trial over a
period of 12 months, we evaluated a total of 38 patients (20 M/18 F) aged
32-68 years with a creatinine clearance (CCr) of 20-36 ml/min. All
patients were receiving EPO (40 U/kg twice a week s.c.) and a low-protein
diet (0.6 g protein/kg/day and 145 kJ/kg/day). The diet of 20 patients
(Group I) was supplemented with KA at a dosage of 100 mg/kg/day while 18
patients (Group II) received no supplementation. During the study period,
the glomerular filtration rate slightly decreased (CCr from 28.2 +/- 3.4
to 26.4 +/- 4.1 ml/min and 29.6 +/- 4.8 to 23.4 +/- 4.4 ml/min in groups I
and II, respectively and Cin); this however was more marked in Group II
(Group I vs. Group II, p < 0.01). The serum levels of urea also declined
(p < 0.01), more pronouncedly in Group I (p < 0.025). In Group I, there
was a significant rise in the levels of leucine (p < 0.01), isoleucine (p
< 0.01), valine (p < 0.02) and albumin (p < 0.01) and a decrease in
protein-uria (p < 0.01). Analysis of the lipid spectrum revealed a mild
yet significant decrease in total cholesterol and LDL-cholesterol (p <
0.02), more pronounced in Group I. In Group I, there was a decrease in
plasma triglycerides (from 4.2 +/- 0.8 down to values a low as 2.2 +/- 0.6
mmol/L; p < 0.01) whereas HDL-cholesterol levels increased (from 0.9 +/-
0.1 to 1.2 +/- 0.1 mmol/L, p < 0.01). A further remarkable finding was a
reduction in the serum concentration of free radicals (p < 0.01). We
conclude that a KA supplementation in patients with CRF receiving LPD and
EPO potentiates the beneficial effects on metabolism of proteins, amino
acids and surprisingly, also lipids. Long-term co-administration of KA,
EPO and LPD was also associated with a delay in progression of renal
insufficiency and a reduction in proteinuria. Thus, concomitant
administration of KA and EPO during a low-protein diet presents an
effective treatment modality in the conservative management of CRF.
PMID: 11603100 [PubMed - indexed for MEDLINE]
Related Links
* Enhanced metabolic effect of erythropoietin and keto acids in
CRF patients on low-protein diet: Czech multicenter study. [Am J Kidney
Dis. 2003] PMID: 12612947
* Effects of low-protein diet supplemented with ketoacids and
erythropoietin in chronic renal failure: a long-term metabolic study. [Ann
Transplant. 2001] PMID: 11803607
* 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. [Wien Klin Wochenschr. 2001] PMID: 11603104
* Effect of a keto acid-amino acid supplement on the metabolism
and renal elimination of branched-chain amino acids in patients with
chronic renal insufficiency on a low protein diet. [Wien Klin Wochenschr.
2000] PMID: 11244613
* Short-term effects of a very-low-protein diet supplemented with
ketoacids in nondialyzed chronic kidney disease patients. [Eur J Clin
Nutr. 2005] PMID: 15354199
PMID: 16509933
Oct 11 2006 09:10:35
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Eur J Clin Nutr. 2005 Jan;59(1):129-36.
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