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Very low protein diets supplemented with keto-analogues in ESRD predialysis patients and its effect on vascular stiffness and AVF Maturation.
BMC Nephrol. 2016 09 20; 17(1):131.BN

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Links

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Authors+Show Affiliations

David C
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.
Peride I
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.
Niculae A
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.
Constantin AM
Bucharest University of Economic Studies, Bucharest, Romania.
Checherita IA
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.

MeSH

AdultAgedAmino Acids, EssentialArteriovenous Shunt, SurgicalC-Reactive ProteinCohort StudiesDiet, Protein-RestrictedFemaleHumansKeto AcidsKidney Failure, ChronicMaleMiddle AgedProspective StudiesRenal DialysisTreatment OutcomeVascular Stiffness

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27644118

Citation

David, Cristiana, et al. "Very Low Protein Diets Supplemented With Keto-analogues in ESRD Predialysis Patients and Its Effect On Vascular Stiffness and AVF Maturation." BMC Nephrology, vol. 17, no. 1, 2016, p. 131.
David C, Peride I, Niculae A, et al. Very low protein diets supplemented with keto-analogues in ESRD predialysis patients and its effect on vascular stiffness and AVF Maturation. BMC Nephrol. 2016;17(1):131.
David, C., Peride, I., Niculae, A., Constantin, A. M., & Checherita, I. A. (2016). Very low protein diets supplemented with keto-analogues in ESRD predialysis patients and its effect on vascular stiffness and AVF Maturation. BMC Nephrology, 17(1), 131. https://doi.org/10.1186/s12882-016-0347-y
David C, et al. Very Low Protein Diets Supplemented With Keto-analogues in ESRD Predialysis Patients and Its Effect On Vascular Stiffness and AVF Maturation. BMC Nephrol. 2016 09 20;17(1):131. PubMed PMID: 27644118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Very low protein diets supplemented with keto-analogues in ESRD predialysis patients and its effect on vascular stiffness and AVF Maturation. AU - David,Cristiana, AU - Peride,Ileana, AU - Niculae,Andrei, AU - Constantin,Alexandra Maria, AU - Checherita,Ionel Alexandru, Y1 - 2016/09/20/ PY - 2016/05/10/received PY - 2016/09/08/accepted PY - 2016/9/21/entrez PY - 2016/9/21/pubmed PY - 2017/11/7/medline KW - Arterial stiffness KW - Arteriovenous fistula maturation KW - End-stage renal disease KW - Ketoacid analogues of essential amino acids SP - 131 EP - 131 JF - BMC nephrology JO - BMC Nephrol VL - 17 IS - 1 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/27644118/Very_low_protein_diets_supplemented_with_keto_analogues_in_ESRD_predialysis_patients_and_its_effect_on_vascular_stiffness_and_AVF_Maturation_ DB - PRIME DP - Unbound Medicine ER -