Comparative evaluation of efficacy and safety profile of rhubarb and α-keto analogs of essential amino acids supplementation in patients with diabetic nephropathy

Abstract

To determine the efficacy and safety profile of rhubarb and α-keto analogs of essential amino acids supplementation in patients of diabetic nephropathy (DN), we studied 96 patients of DN attending a tertiary care center of the North India. The patients were randomly divided into three equal interventional groups. Group I (control) that received conservative management along with placebo, Group II (rhubarb) that received conservative management along with rhubarb capsule (350 mg, thrice daily), and Group III [keto amino acid (KAA)] that received conservative management along with α-keto analogs of essential amino acids (600 mg, thrice daily). The treatment was continued for 12 weeks. Clinical and biochemical parameters were assessed at 0, 4, 8, and 12 weeks of treatment. A progressive improvement in clinical features and biochemical parameters was seen in all three groups after 12 weeks of treatment. The KAA group showed more marked improvement in clinical features as well as biochemical parameters compared to the rhubarb group. There was a reduction in blood glucose, blood urea, serum creatinine, and 24 h total urine protein. There was an increase in hemoglobin, 24 h total urine volume, and glomerular filtration rate. There was no statistical difference between the rhubarb and KAA groups with respect to side effects (P > 0.05). Our study suggests that KAA is more effective than rhubarb as add-on therapy with conservative management in patients of DN.

Anti-hyperglycemic Effects of Diacerein in Alloxan-Induced Diabetes Mellitus in Wistar Albino Rats

“…The present study reveals body weight, blood glucose, HbA1c, serum insulin and GPX were significantly improved in diacerein treated diabetic rats. The findings of current study are consistent with earlier studies [17,[22][23][24]. A double-blind randomized placebo control trial was concluded that the diacerein has an effect on β-cell secretory physiology [22].…”

“…The study evaluated the outcome of β-cell physiology by estimating and comparing the blood sugar and insulin in controls, diabetic controls and diacerein treated diabetic rats. The experimental and clinical trials have reported that diacereinis effective in treating diabetes mellitus [17], left ventricular dysfunction [18] and relieving the visceral pain [19]. A previous study reported its use in breast cancer [20].…”

Ketoanalogue Supplementation in Patients with Non-Dialysis Diabetic Kidney Disease: A Systematic Review and Meta-Analysis

“…A manual review of references cited in the studies yielded 2 additional citations, resulting in a total of 27 articles that were formally assessed for eligibility. Eleven of these studies were identified for the systematic review (Table 2) [2,8,12,[23][24][25][26][27][28][29][30]. Agreement between 2 researchers was high.…”

“…Ketoacid analogues of EAA (ketoanalogues; KA) can serve as substrates for protein synthesis without the production of toxic nitrogenous waste products [11]. Thus, supplementation of a protein-restricted diet with KA allows a reduced intake of nitrogen while avoiding the deleterious consequences of inadequate dietary protein intake, mainly on muscle metabolism [12]. In nondiabetic patients with CKD, supplementation of a low protein diet (LPD) or very-low-protein diet (VLPD) with KA has been shown to have additional advantages on uremic control, reduce CKD-related cardiovascular risk factors, attenuate the disease progression, and delay the requirement for maintenance dialysis therapy while being nutritionally safe [13][14][15][16][17][18].…”

The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis

“…Ketoanalogues of amino acids (KAs) are nitrogen-free analogs of essential amino acids. “Ketodiet” refers to a variety of KA and low-protein diets (LPDs; 0.6 g/kg per day) or very-low-protein diets (VLPDs; 0.3–0.4 g/kg per day), which allow a reduced intake of nitrogen while avoiding the deleterious consequences of inadequate dietary protein intake and malnourishment [6]. These diets have been proven effective in reducing renal death in selected, well-nourished, progressive CKD patients with proven diet adherence and low-comorbidity [7].…”