Effect of essential amino acid кetoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Кlotho) in 3b-4 stages chronic кidney disease patients: a randomized pilot study.
Clin Exp Nephrol. 2018 Dec; 22(6):1351-1359.CE

Abstract

BACKGROUND

A low protein diet (LPD) with essential amino acid ketoanalogue supplementation (KA) may contribute in improving of chronic kidney disease (CKD), while the exact mechanisms of KA's effect are not established yet. We have conducted a prospective, randomized, controlled comparative study of LPD + KA and LPD alone in relation to serum Klotho, FGF-23 levels in CKD patients.

METHODS

79 non-diabetic CKD 3b-4 stage patients, compliant with LPD diet (0.6 g/kg of body weight/day), had been selected. The patients were randomized into two groups. The first group (42 patients) received LPD + КA. The second group (37 patients) continued the LРD alone. In addition to routine tests, serum Klotho, FGF-23 levels, as well as bioimpedance analysis, sphygmography (stiffness (augmentation) indices (AI), central (aortal) blood pressure) with a «SphygmaCor» device; echocardiography (valvular calcification score (VCS) and LVMMI), were performed.

RESULTS

There were body mass indices' decrease (p = 0.046), including muscle body mass in men (p = 0.027) and woman (p = 0.044) in the LPD group to the end of study (14th month). In addition, lower FGF-23 (p = 0.029), and higher sKlotho (p = 0.037) were detected in the LPD + KA group compared to the LPD one. The increase in AI (p = 0.034), VCS (p = 0.048), and LVMMI (p = 0.023) was detected more often in the LPD group at the end of study.

CONCLUSION

LPD + KA provides support for nutrition status and contributes to more efficient correction of FGF-23 and Klotho abnormalities that may result in cardiovascular calcification and cardiac remodeling decreasing in CKD. At the same time, a prolonged LPD alone may lead to malnutrition.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Milovanova L

Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya str. 8, bld.2, Moscow, 119991, Russian Federation. ludm.milovanova@gmail.com. Clinic of Nephrology and Internal Diseases, Rossolimo str. 11, bld. 5, Moscow, 119992, Russian Federation. ludm.milovanova@gmail.com.

Fomin V

Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya str. 8, bld.2, Moscow, 119991, Russian Federation. Department of Faculty Therapy No. 1, Bolshaya Pirogovskaya str., 6, bld 1., Moscow, 119435, Russian Federation.

Moiseev S

Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya str. 8, bld.2, Moscow, 119991, Russian Federation. Clinic of Nephrology and Internal Diseases, Rossolimo str. 11, bld. 5, Moscow, 119992, Russian Federation.

Taranova M

Milovanov Y

Lysenko Kozlovskaya L

Kozlov V

Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya str. 8, bld.2, Moscow, 119991, Russian Federation. Department of Public Health and Health Care Organization, Bolshaya Pirogovskaya str. 2, bld. 2, Moscow, 119435, Russian Federation.

MeSH

Amino Acids, EssentialDiet, Protein-RestrictedFemaleFibroblast Growth Factor-23Fibroblast Growth FactorsGlucuronidaseHumansHypertrophy, Left VentricularKlotho ProteinsMaleMalnutritionPilot ProjectsProspective StudiesRenal Insufficiency, ChronicVascular Calcification

Pub Type(s)

Comparative Study

Journal Article

Randomized Controlled Trial

Language

eng

PubMed ID

29948444

Citation

Milovanova, Lyudmila, et al. "Effect of Essential Amino Acid Кetoanalogues and Protein Restriction Diet On Morphogenetic Proteins (FGF-23 and Кlotho) in 3b-4 Stages Chronic Кidney Disease Patients: a Randomized Pilot Study." Clinical and Experimental Nephrology, vol. 22, no. 6, 2018, pp. 1351-1359.

Milovanova L, Fomin V, Moiseev S, et al. Effect of essential amino acid кetoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Кlotho) in 3b-4 stages chronic кidney disease patients: a randomized pilot study. Clin Exp Nephrol. 2018;22(6):1351-1359.

Milovanova, L., Fomin, V., Moiseev, S., Taranova, M., Milovanov, Y., Lysenko Kozlovskaya, L., Kozlov, V., Kozevnikova, E., Milovanova, S., Lebedeva, M., & Reshetnikov, V. (2018). Effect of essential amino acid кetoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Кlotho) in 3b-4 stages chronic кidney disease patients: a randomized pilot study. Clinical and Experimental Nephrology, 22(6), 1351-1359. https://doi.org/10.1007/s10157-018-1591-1

Milovanova L, et al. Effect of Essential Amino Acid Кetoanalogues and Protein Restriction Diet On Morphogenetic Proteins (FGF-23 and Кlotho) in 3b-4 Stages Chronic Кidney Disease Patients: a Randomized Pilot Study. Clin Exp Nephrol. 2018;22(6):1351-1359. PubMed PMID: 29948444.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Effect of essential amino acid кetoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Кlotho) in 3b-4 stages chronic кidney disease patients: a randomized pilot study. AU - Milovanova,Lyudmila, AU - Fomin,Victor, AU - Moiseev,Sergey, AU - Taranova,Marina, AU - Milovanov,Yury, AU - Lysenko Kozlovskaya,Lidia, AU - Kozlov,Vasiliy, AU - Kozevnikova,Elena, AU - Milovanova,Svetlana, AU - Lebedeva,Marina, AU - Reshetnikov,Vladimir, Y1 - 2018/06/11/ PY - 2017/05/16/received PY - 2018/05/17/accepted PY - 2018/6/28/pubmed PY - 2019/3/8/medline PY - 2018/6/28/entrez KW - Cardiac remodeling KW - Cardiovascular calcification KW - Chronic kidney disease KW - Essential amino acid ketoanalogues KW - Fibroblast growth factor-23 (FGF-23) KW - Serum alpha-Klotho (sKlotho) SP - 1351 EP - 1359 JF - Clinical and experimental nephrology JO - Clin Exp Nephrol VL - 22 IS - 6 N2 - BACKGROUND: A low protein diet (LPD) with essential amino acid ketoanalogue supplementation (KA) may contribute in improving of chronic kidney disease (CKD), while the exact mechanisms of KA's effect are not established yet. We have conducted a prospective, randomized, controlled comparative study of LPD + KA and LPD alone in relation to serum Klotho, FGF-23 levels in CKD patients. METHODS: 79 non-diabetic CKD 3b-4 stage patients, compliant with LPD diet (0.6 g/kg of body weight/day), had been selected. The patients were randomized into two groups. The first group (42 patients) received LPD + КA. The second group (37 patients) continued the LРD alone. In addition to routine tests, serum Klotho, FGF-23 levels, as well as bioimpedance analysis, sphygmography (stiffness (augmentation) indices (AI), central (aortal) blood pressure) with a «SphygmaCor» device; echocardiography (valvular calcification score (VCS) and LVMMI), were performed. RESULTS: There were body mass indices' decrease (p = 0.046), including muscle body mass in men (p = 0.027) and woman (p = 0.044) in the LPD group to the end of study (14th month). In addition, lower FGF-23 (p = 0.029), and higher sKlotho (p = 0.037) were detected in the LPD + KA group compared to the LPD one. The increase in AI (p = 0.034), VCS (p = 0.048), and LVMMI (p = 0.023) was detected more often in the LPD group at the end of study. CONCLUSION: LPD + KA provides support for nutrition status and contributes to more efficient correction of FGF-23 and Klotho abnormalities that may result in cardiovascular calcification and cardiac remodeling decreasing in CKD. At the same time, a prolonged LPD alone may lead to malnutrition. SN - 1437-7799 UR - https://www.unboundmedicine.com/medline/citation/29948444/Effect_of_essential_amino_acid_кetoanalogues_and_protein_restriction_diet_on_morphogenetic_proteins__FGF_23_and_Кlotho__in_3b_4_stages_chronic_кidney_disease_patients:_a_randomized_pilot_study_ DB - PRIME DP - Unbound Medicine ER -

Tags

Effect of essential amino acid кetoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Кlotho) in 3b-4 stages chronic кidney disease patients: a randomized pilot study.Clin Exp Nephrol. 2018 Dec; 22(6):1351-1359.CE