There is no consensus as to how to correct the malnutrition-inflammation complex syndrome in chronic kidney disease patients. Because the malnutrition-inflammation complex syndrome is multifactorial, its correction probably requires a battery of simultaneous interventions, rather than one single modality. Clinical trials focusing on the syndrome are currently non-existent and are therefore urgently required to improve poor clinical outcome in chronic kidney disease patients.
The effect of age on theophylline kinetics was examined in six normal young men and six elderly men. There were no age-associated differences in theophylline volume of distribution, total clearance, or t1/2. The unbound fraction of theophylline was significantly raised in the elderly (mean 77.7% vs. 62.3%, p less than 0.001) and was correlated with the serum albumin level (r = -0.7, p less than 0.01). Theophylline nonrenal clearance was not changed, but the total unbound clearance was significantly reduced in the elderly subjects as compared with the young ones (mean 0.744 vs. 1.085 ml/min/kg, p less than 0.05). Creatinine clearance was reduced in the elderly and was significantly correlated with unbound renal clearance (r = 0.6, p less than 0.04). There were no age-related differences in the urinary excretion of theophylline, 1-methyluric acid, 3-methylxanthine, or 1,3-dimethyluric acid. However, significant reduction in unbound renal theophylline clearance (p less than 0.002) as well as the unbound metabolic clearance of 1,3-dimethyluric acid (p less than 0.03), 3-methylxanthine (p less than 0.04), and 1-methyluric acid (p less than 0.02) were observed in the elderly subjects. These observations indicate that both renal and metabolic elimination processes for theophylline are less active in the normal elderly.
The effect of a low calorie (1100 kcal), low protein (35 g) intake for 9 days on nutritional and laboratory parameters was studied in six young and six elderly healthy subjects. All subjects lost weight on the test diet (an average of 2.0 kg in the young and 2.1 kg in the elderly). Basal serum albumin, serum transferrin, creatinine height index, and creatinine clearance in the elderly subjects were lower than in the young (p less than 0.05). Serum albumin remained unchanged at the end of diet in both groups. There was, however, a significant decrease in the transferrin level in the younger subjects (p less than 0.01). The decrease in creatinine height index was not significant in either group. Baseline nitrogen balance of the elderly was -1.1 g/day compared to +0.5 g/day (p less than 0.01) in the young subjects. The test diet caused a negative nitrogen balance of about -5 g/day in both groups (p less than 0.005). Blood urea nitrogen was significantly lower at the end of the test diet and was related to the intake of protein in both groups. At the end of the diet the serum potassium and GGT were significantly lower in the young (p less than 0.01); serum creatinine was unchanged but creatinine clearance was significantly lower in both groups. From this study it appears that significant changes occur in nutritional and laboratory parameters within 9 days on a diet deficient in calories and protein in normal healthy subjects. These changes need to be recognized as having nutritional basis and should not be attributed to illness or drug therapy.
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