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Effect of a ketoacid-aminoacid-supplemented very low protein diet on the progression of advanced renal disease: a reanalysis of the MDRD feasibility study.
Clin Nephrol. 1998 Nov; 50(5):273-83.CN

Abstract

BACKGROUND

We reanalyzed the data of the Modification of Diet in Renal Disease (MDRD) feasibility study to ascertain the effects of ketoacid- and aminoacid-supplemented very low protein diets.

METHODS

Sixty-six patients with advanced renal disease (Study B, baseline glomerular filtration rate (GFR) 7.5-24 ml/min/1.73 m2) were randomly assigned to a low protein diet (L, 0.575 g/kg/d), or a very low protein diet (0.28 g/kg/d) supplemented either with a ketoacid-aminoacid mixture (diet K) or with a mixture of essential aminoacids (diet J). Thirty patients with moderate renal disease (Study A, baseline GFR 25-80 ml/min/1.73 m2) were randomly assigned to a usual protein diet (M, 1.2 g/kg/d), diet L, or diet K. Mean follow-up was 14 months.

RESULTS

In Study B, GFR decline differed among the three diets (p = 0.028). Pairwise comparisons showed that the mean +/- SE GFR decline in ml/min/mo in diet K [-0.250+/-0.072] was slower than in diet J [-0.533+/-0.074] (p = 0.008) despite similar achieved protein intakes. The mean GFR decline in diet L [-0.394+/-0.068] was intermediate between, and did not differ significantly from the rates of decline in the other two groups. In Study A, consistent with a hemodynamic effect, the mean GFR decline varied directly with the reduction in protein intake in diets M, L and K (p = 0.028) during the first four months of follow-up, but thereafter did not differ among the diet groups (p = 0.76).

CONCLUSION

The study suggests that supplementation of a very low protein diet with the ketoacid-aminoacid mixture used in this feasibility study slowed the progression of advanced renal disease more than supplementation with an amino acid mixture.

Authors+Show Affiliations

Vanderbilt University, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Clinical Trial, Phase II
Clinical Trial, Phase III
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

9840314

Citation

Teschan, P E., et al. "Effect of a Ketoacid-aminoacid-supplemented Very Low Protein Diet On the Progression of Advanced Renal Disease: a Reanalysis of the MDRD Feasibility Study." Clinical Nephrology, vol. 50, no. 5, 1998, pp. 273-83.
Teschan PE, Beck GJ, Dwyer JT, et al. Effect of a ketoacid-aminoacid-supplemented very low protein diet on the progression of advanced renal disease: a reanalysis of the MDRD feasibility study. Clin Nephrol. 1998;50(5):273-83.
Teschan, P. E., Beck, G. J., Dwyer, J. T., Greene, T., Klahr, S., Levy, A. S., Mitch, W. E., Snetselaar, L. G., Steinman, T. I., & Walser, M. (1998). Effect of a ketoacid-aminoacid-supplemented very low protein diet on the progression of advanced renal disease: a reanalysis of the MDRD feasibility study. Clinical Nephrology, 50(5), 273-83.
Teschan PE, et al. Effect of a Ketoacid-aminoacid-supplemented Very Low Protein Diet On the Progression of Advanced Renal Disease: a Reanalysis of the MDRD Feasibility Study. Clin Nephrol. 1998;50(5):273-83. PubMed PMID: 9840314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of a ketoacid-aminoacid-supplemented very low protein diet on the progression of advanced renal disease: a reanalysis of the MDRD feasibility study. AU - Teschan,P E, AU - Beck,G J, AU - Dwyer,J T, AU - Greene,T, AU - Klahr,S, AU - Levy,A S, AU - Mitch,W E, AU - Snetselaar,L G, AU - Steinman,T I, AU - Walser,M, PY - 1998/12/5/pubmed PY - 1998/12/5/medline PY - 1998/12/5/entrez SP - 273 EP - 83 JF - Clinical nephrology JO - Clin Nephrol VL - 50 IS - 5 N2 - BACKGROUND: We reanalyzed the data of the Modification of Diet in Renal Disease (MDRD) feasibility study to ascertain the effects of ketoacid- and aminoacid-supplemented very low protein diets. METHODS: Sixty-six patients with advanced renal disease (Study B, baseline glomerular filtration rate (GFR) 7.5-24 ml/min/1.73 m2) were randomly assigned to a low protein diet (L, 0.575 g/kg/d), or a very low protein diet (0.28 g/kg/d) supplemented either with a ketoacid-aminoacid mixture (diet K) or with a mixture of essential aminoacids (diet J). Thirty patients with moderate renal disease (Study A, baseline GFR 25-80 ml/min/1.73 m2) were randomly assigned to a usual protein diet (M, 1.2 g/kg/d), diet L, or diet K. Mean follow-up was 14 months. RESULTS: In Study B, GFR decline differed among the three diets (p = 0.028). Pairwise comparisons showed that the mean +/- SE GFR decline in ml/min/mo in diet K [-0.250+/-0.072] was slower than in diet J [-0.533+/-0.074] (p = 0.008) despite similar achieved protein intakes. The mean GFR decline in diet L [-0.394+/-0.068] was intermediate between, and did not differ significantly from the rates of decline in the other two groups. In Study A, consistent with a hemodynamic effect, the mean GFR decline varied directly with the reduction in protein intake in diets M, L and K (p = 0.028) during the first four months of follow-up, but thereafter did not differ among the diet groups (p = 0.76). CONCLUSION: The study suggests that supplementation of a very low protein diet with the ketoacid-aminoacid mixture used in this feasibility study slowed the progression of advanced renal disease more than supplementation with an amino acid mixture. SN - 0301-0430 UR - https://www.unboundmedicine.com/medline/citation/9840314/Effect_of_a_ketoacid_aminoacid_supplemented_very_low_protein_diet_on_the_progression_of_advanced_renal_disease:_a_reanalysis_of_the_MDRD_feasibility_study_ DB - PRIME DP - Unbound Medicine ER -