Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial

Abstract

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.

Improved plasma amino acids pattern following 12 months of supplemented low-protein diet in peritoneal dialysis patients

“…As previously reported, 13 we conducted a prospective, open-label randomized controlled trial in 60 stable PD patients utilizing either high-protein diet (HP: dietary protein intake, DPI, of 1.0-1.2 g/kg ideal body weight [IBW]/d), low-protein diet (LP: DPI of 0.6-0.8 g/kg IBW/d), or keto acids-supplemented low-protein diet (sLP: DPI of 0.6-0.8 g/kg IBW/d plus 0.12 g/kg IBW/d of keto acids) during 1 year. According to current guidelines, the prescribed total energy intake (TEI), including PD glucose, 14 was 35 kcal/kg IBW for patients below 60 years of age and 30 kcal/kg IBW for those above.…”

“…Kidney plays a role in amino acids metabolism in these patients, including NEAA utilization and excretion. 24 As our previous published data show that patients in group sLP preserve residual renal function better, 13 the increase of E/NEAA ratio may suggest an improved release of NEAA accumulation in group sLP. On the other hand, the use of keto acids in uremic patients could supply EAA for protein synthesis at the expense of endogenous nonessential nitrogen, 12 which may also explain the decrease of NEAA in patients on keto acids-supplemented diets.…”

“…In a supplemental analysis of material collected during a previously published 13 prospective and randomized trial of PD patients, we report that diets low in protein (DPI of 0.6-0.8 g/IBW kg/d) but supplemented with 0.12 g/kg IBW/d of keto acids can improve the E/ NEAA ratio in a cohort of 39 patients treated for 12 months. Neither low-protein diet alone nor highprotein diet without supplementation is able to affect the same change.…”

“…13 Briefly, stable PD patients with a urine output of more than 800 mL or estimated glomerular filtration rate (e-GFR) of greater than 2 mL/min/1.73 m 2 were recruited. Exclusion criteria were transplantation plan within 1 year, overt infection or persistent anorexia, vomiting, or diarrhea within the last month, and presence of wasting diseases such as cancer or tuberculosis.…”

“…12 It is now unknown whether dietary intervention, which is low in protein and supplemented with keto acids, would do favor for AA metabolism in PD patients. We recently published data 13 suggesting that supplemented low-protein diet is associated with maintenance of residual renal function without altering nutritional status in a randomized controlled trial of PD patients, which did not directly measure plasma AA levels. We thus reevaluated a subset of the original patients whose blood sample was available and measured their circulating EAA and NEAA levels and then related these levels to diet composition and clinical parameters.…”