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Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial.
Nephrol Dial Transplant. 2009 Aug; 24(8):2551-8.ND

Abstract

BACKGROUND

While a low-protein diet may preserve residual renal function (RRF) in chronic kidney disease (CKD) patients before the start of dialysis, a high-protein intake is usually recommended in dialysis patients to prevent protein-energy wasting. Keto acids, which were often recommended to pre-dialysis CKD patients treated with a low-protein diet, had also been reported to be associated with both RRF and nutrition maintenance. We conducted a randomized trial to test whether a low-protein diet with or without keto acids would be safe and associated with a preserved RRF during peritoneal dialysis (PD).

METHODS

To assess the safety of low protein, we first conducted a nitrogen balance study in 34 incident PD patients randomized to receive in-centre diets containing 1.2, 0.9 or 0.6 g of protein/kg ideal body weight (IBW)/day for 10 days. Second, 60 stable PD patients [RRF 4.04 +/- 2.30 ml/ min/1.73 m(2), urine output 1226 +/- 449 ml/day, aged 53.6 +/- 12.8 years, PD duration 8.8 (1.5-17.8) months] were randomized to receive either a low- (LP: 0.6-0.8 g/kg IBW/day), keto acid-supplemented low- (sLP: 0.6-0.8 g/kg IBW/day with 0.12 g/kg IBW/day of keto acids) or high-protein (HP: 1.0-1.2 g/kg IBW/day) diet. The groups were followed for 1 year and RRF as well as nutritional status was evaluated serially.

RESULTS

A neutral or positive nitrogen balance was achieved in all three groups. RRF remained stable in group sLP (3.84 +/- 2.17 to 3.39 +/- 3.23 ml/min/1.73 m(2), P = ns) while it decreased in group LP (4.02 +/- 2.49 to 2.29 +/- 1.72 ml/min/1.73 m(2), P < 0.05) and HP (4.25 +/- 2.34 to 2.55 +/- 2.29 ml/min/1.73 m(2), P < 0.05). There was no change from baseline on nutritional status in any of the groups during follow-up.

CONCLUSIONS

A diet containing 0.6-0.8 g of protein/kg IBW/day is safe and, when combined with keto acids, is associated with an improved preservation of RRF in relatively new PD patients without significant malnutrition or inflammation.

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Authors+Show Affiliations

Jiang N
Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Center for Peritoneal DialysisResearch, Shanghai, People's Republic of China.
Qian J
No affiliation info available
Sun W
No affiliation info available
Lin A
No affiliation info available
Cao L
No affiliation info available
Wang Q
No affiliation info available
Ni Z
No affiliation info available
Wan Y
No affiliation info available
Linholm B
No affiliation info available
Axelsson J
No affiliation info available
Yao Q
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overDietary ProteinsDietary SupplementsFemaleFollow-Up StudiesHumansKeto AcidsKidney Failure, ChronicKidney Function TestsMaleMiddle AgedNitrogenPeritoneal DialysisProspective StudiesTissue DistributionYoung Adult

Pub Type(s)

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

Language

eng

PubMed ID

19258386

Citation

Jiang, Na, et al. "Better Preservation of Residual Renal Function in Peritoneal Dialysis Patients Treated With a Low-protein Diet Supplemented With Keto Acids: a Prospective, Randomized Trial." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 24, no. 8, 2009, pp. 2551-8.
Jiang N, Qian J, Sun W, et al. Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. Nephrol Dial Transplant. 2009;24(8):2551-8.
Jiang, N., Qian, J., Sun, W., Lin, A., Cao, L., Wang, Q., Ni, Z., Wan, Y., Linholm, B., Axelsson, J., & Yao, Q. (2009). Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 24(8), 2551-8. https://doi.org/10.1093/ndt/gfp085
Jiang N, et al. Better Preservation of Residual Renal Function in Peritoneal Dialysis Patients Treated With a Low-protein Diet Supplemented With Keto Acids: a Prospective, Randomized Trial. Nephrol Dial Transplant. 2009;24(8):2551-8. PubMed PMID: 19258386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. AU - Jiang,Na, AU - Qian,Jiaqi, AU - Sun,Weilan, AU - Lin,Aiwu, AU - Cao,Liou, AU - Wang,Qin, AU - Ni,Zhaohui, AU - Wan,Yanping, AU - Linholm,Bengt, AU - Axelsson,Jonas, AU - Yao,Qiang, Y1 - 2009/03/03/ PY - 2009/3/5/entrez PY - 2009/3/5/pubmed PY - 2009/10/23/medline SP - 2551 EP - 8 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 24 IS - 8 N2 - BACKGROUND: While a low-protein diet may preserve residual renal function (RRF) in chronic kidney disease (CKD) patients before the start of dialysis, a high-protein intake is usually recommended in dialysis patients to prevent protein-energy wasting. Keto acids, which were often recommended to pre-dialysis CKD patients treated with a low-protein diet, had also been reported to be associated with both RRF and nutrition maintenance. We conducted a randomized trial to test whether a low-protein diet with or without keto acids would be safe and associated with a preserved RRF during peritoneal dialysis (PD). METHODS: To assess the safety of low protein, we first conducted a nitrogen balance study in 34 incident PD patients randomized to receive in-centre diets containing 1.2, 0.9 or 0.6 g of protein/kg ideal body weight (IBW)/day for 10 days. Second, 60 stable PD patients [RRF 4.04 +/- 2.30 ml/ min/1.73 m(2), urine output 1226 +/- 449 ml/day, aged 53.6 +/- 12.8 years, PD duration 8.8 (1.5-17.8) months] were randomized to receive either a low- (LP: 0.6-0.8 g/kg IBW/day), keto acid-supplemented low- (sLP: 0.6-0.8 g/kg IBW/day with 0.12 g/kg IBW/day of keto acids) or high-protein (HP: 1.0-1.2 g/kg IBW/day) diet. The groups were followed for 1 year and RRF as well as nutritional status was evaluated serially. RESULTS: A neutral or positive nitrogen balance was achieved in all three groups. RRF remained stable in group sLP (3.84 +/- 2.17 to 3.39 +/- 3.23 ml/min/1.73 m(2), P = ns) while it decreased in group LP (4.02 +/- 2.49 to 2.29 +/- 1.72 ml/min/1.73 m(2), P < 0.05) and HP (4.25 +/- 2.34 to 2.55 +/- 2.29 ml/min/1.73 m(2), P < 0.05). There was no change from baseline on nutritional status in any of the groups during follow-up. CONCLUSIONS: A diet containing 0.6-0.8 g of protein/kg IBW/day is safe and, when combined with keto acids, is associated with an improved preservation of RRF in relatively new PD patients without significant malnutrition or inflammation. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/19258386/Better_preservation_of_residual_renal_function_in_peritoneal_dialysis_patients_treated_with_a_low_protein_diet_supplemented_with_keto_acids:_a_prospective_randomized_trial_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfp085 DB - PRIME DP - Unbound Medicine ER -