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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.
Wien Klin Wochenschr. 2001 Sep 17; 113(17-18):661-9.WK

Abstract

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.

Authors+Show Affiliations

Teplan V
Department of Nephrology, Institute for Clinical and Experimental Medicine, Postgraduate Medical School, Prague, Czech Republic. vladimir.teplan@medicon.cz
Schück O
No affiliation info available
Votruba M
No affiliation info available
Poledne R
No affiliation info available
Kazdová L
No affiliation info available
Skibová J
No affiliation info available
Malý J
No affiliation info available

MeSH

AdultAgedAmino AcidsAmino Acids, Branched-ChainAmino Acids, EssentialDiet, Protein-RestrictedErythropoietinFemaleFood, FormulatedFree RadicalsHumansKeto AcidsKidney Failure, ChronicLipoproteinsMaleMiddle AgedProspective StudiesProteinsProteinuriaRecombinant ProteinsTreatment Outcome

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11603100

Citation

Teplan, V, et al. "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." Wiener Klinische Wochenschrift, vol. 113, no. 17-18, 2001, pp. 661-9.
Teplan V, Schück O, Votruba M, et al. 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. Wien Klin Wochenschr. 2001;113(17-18):661-9.
Teplan, V., Schück, O., Votruba, M., Poledne, R., Kazdová, L., Skibová, J., & Malý, J. (2001). 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. Wiener Klinische Wochenschrift, 113(17-18), 661-9.
Teplan V, et al. 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. Wien Klin Wochenschr. 2001 Sep 17;113(17-18):661-9. PubMed PMID: 11603100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Teplan,V, AU - Schück,O, AU - Votruba,M, AU - Poledne,R, AU - Kazdová,L, AU - Skibová,J, AU - Malý,J, PY - 2001/10/18/pubmed PY - 2002/1/5/medline PY - 2001/10/18/entrez SP - 661 EP - 9 JF - Wiener klinische Wochenschrift JO - Wien Klin Wochenschr VL - 113 IS - 17-18 N2 - 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. SN - 0043-5325 UR - https://www.unboundmedicine.com/medline/citation/11603100/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_ L2 - https://medlineplus.gov/kidneyfailure.html DB - PRIME DP - Unbound Medicine ER -