Dietary Management of Chronic Renal Failure with Oral Amino Acids

Abstract

6 patients in end-stage renal failure of varying aetiologies have been studied on low protein dietary regimens according to a P 6 formulation. All patients had part of their daily protein allowance substituted by an essential amino acid capsule also containing histidine and glutamic acid. All patients were maintained in nutritional balance as a result of the regimens prescribed. No toxic effects were noted and patient compliance was good. Our studies suggest the amino acid formulation given is safe and did not cause any fluctuations in patient plasma amino acid profiles. Our studies suggest an improved method of low protein dietary management for chronic renal failure patients together with a greater flexibility and wider range of prescribing possibilities. It is recommended that amino acid supplements according to the formula produced here constitute an improvement on currently prescribed Giovannetti regimens.

Increased Intestinal Permeability to Differently Sized Polyethylene Glycols in Uremic Rats: Effects of Low- and High-Protein Diets

“…Symptoms, such as nausea, vomiting and anorexia, are common in advanced renal failure. Reduc tion of the dietary protein intake is an important treatment of patients with chronic uremia [1,2], Absorption of nu trients proceeds actively, primarily via transcellular path ways (transcytosis), but may also occur passively via a paracellular route [3][4][5]. Intestinal function has been studied extensively by several authors [6][7][8].…”

Nutrition in Renal Failure

“…Whether the supplementation, substitution or addition of EAA or keto-acid analogues have anything to offer over and above a strict low-protein diet remains to be seen (Lee & Jackson, 1981 ;Mitch et al 1982;Mitch, 1988). It has been argued that by having available EAA supplements then the nature of the protein intake can be derestricted inasmuch as high and low biological value proteins can be eaten, thereby increasing dietary choice (Lee et al 1980(Lee et al , 1987. Such an approach is probably more valuable in patients with advanced C R F (serum creatinine > 850 ,umol/l) where symptomatic relief is sought more than any pretence at particular deceleration of renal function deterioration.…”

Nitrogen Balance Studies in Patients with Uremia during Treatment with Protein-Reduced Diet and Supplementation with Essential Amino Acids or Keto Acids

“…In advanced cases, a limitation of the daily protein intake to about 20 g is usually neces sary. However, nitrogen balance is not at tained with this diet only, but requires sup plementation with the essential amino acids and histidine [2,4,7,15,16], Good clinical long-term results have been reported with this treatment [3,15]. The lower serum urea level is attributed to the reduced protein in take, improved intake of energy and nu trients with a decreased catabolic rate and reutilization of some nitrogen-containing metabolites for amino acid synthesis.…”

“…Nitro gen balance could be achieved despite the lower nitrogen intake and the reduction of serum urea was more pronounced than after supplementation with the essential amino acids. In certain studies the treatment was reported to improve the residual renal func tion [22,25], In later years several reports on the bene ficial experimental and clinical effects of this treatment have been published [4,8,13,22], but critical voices have also been raised ques tioning the advisability of a more widespread use of the hitherto expensive keto acids [7,9,16].…”