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

Attman, Per‐Ola; Bucht, H; Isaksson, B; Uddebom, Gunilla

doi:10.1159/000176779

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…Hypercalcemia occasionally has been reported 92,98 Abbreviations: BP, blood pressure; CKD, chronic kidney disease; ESAs, erythropoiesis-stimulating agents; GFR, glomerular filtration rate; KA/EAA, ketoacid/essential amino acid; LPDs, low-protein diets; MDRD, Modification of Diet in Renal Disease; PTH, parathyroid hormone; RAAS, renin-angiotensin-aldosterone system; RRT, renal replacement therapy; SVLPDs, supplemented very-low-protein diets.…”

Section: Improves Sensitivity To Esasmentioning

confidence: 99%

“…90 The few studies that directly compared KA/EAA-and EAA-supplemented VLPDs usually evaluated small numbers of patients and suggested either no differences or possibly modest advantages to the KA/EAA-supplemented VLPD in terms of lower serum urea, phosphorus, and possibly triglyceride levels. 8,28,41,92,93 Two randomized studies indicated slower GFR loss with the KA/EAA-versus EAA-supplemented VLPD. 46,94 …”

Section: Ka/eaa-versus Eaa-supplemented Vlpdsmentioning

confidence: 99%

“…39 Occasionally, hypercalcemia is reported, presumably due to intake of calcium salts of the KA analogues or the decrease in serum phosphorus levels. 92,98 There are no reports of metabolic intolerance to the ketoacid component of KA salts. However, many patients have difficulty accepting and adhering to the KA/EAA-supplemented VLPDs.…”

Section: Potential Limitations Of Ka/ Eaa-supplemented Dietsmentioning

confidence: 99%

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Is There a Role for Ketoacid Supplements in the Management of CKD?

Shah

Kalantar-Zadeh²,

Kopple

2015

American Journal of Kidney Diseases

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Ketoacid (KA) analogues of essential amino acids (EAAs) provide several potential advantages for people with advanced chronic kidney disease (CKD). Because KAs lack the amino group bound to the α carbon of an amino acid, they can be converted to their respective amino acids without providing additional nitrogen. It has been well established that a diet with 0.3 to 0.4 g of protein per kilogram per day that is supplemented with KAs and EAAs reduces the generation of potentially toxic metabolic products, as well as the burden of potassium, phosphorus, and possibly sodium, while still providing calcium. These KA/EAA-supplemented very-low-protein diets (VLPDs) can maintain good nutrition, but the appropriate dose of the KA/EAA supplement has not been established. Thus, a KA/EAA dose-response study for good nutrition clearly is needed. Similarly, the composition of the KA/EAA supplement needs to be reexamined; for example, some KA/EAA preparations contain neither the EAA phenylalanine nor its analogue. Indications concerning when to inaugurate a KA/EAA-supplemented VLPD therapy also are unclear. Evidence strongly suggests that these diets can delay the need for maintenance dialysis therapy, but whether they slow the loss of glomerular filtration rate in patients with CKD is less clear, particularly in this era of more vigorous blood pressure control and use of angiotensin/aldosterone blockade. Some clinicians prescribe KA/EAA supplements for patients with CKD or treated with maintenance dialysis, but with diets that have much higher protein levels than the VLPDs in which these supplements have been studied. More research is needed to examine the effectiveness of KA/EAA supplements with higher protein intakes.

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Section: Improves Sensitivity To Esasmentioning

confidence: 99%

Section: Ka/eaa-versus Eaa-supplemented Vlpdsmentioning

confidence: 99%

Section: Potential Limitations Of Ka/ Eaa-supplemented Dietsmentioning

confidence: 99%

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Is There a Role for Ketoacid Supplements in the Management of CKD?

Shah

Kalantar-Zadeh²,

Kopple

2015

American Journal of Kidney Diseases

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“…During this period keto-analogues to the EAA were developed in Germany to further reduce the nitrogen intake. Nitrogen balance studies indicated that keto-acids could substitute for conventional EAA and were well tolerated by the patients [ 10 ]. This practice was not strongly established in Swedish clinical practice mainly because these supplements were not subsidized.…”

Section: Historical Developmentmentioning

confidence: 99%

A practical approach to low protein diets in Sweden– 45 years of clinical use

et al. 2016

Self Cite

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This review provides an overview of the development, implementation and practise of low protein diets (LPD) in Sweden. While the current practice is discussed in general terms emphasizing the interplay between nephrologists and dieticians, the ”self-selected” LPD model is explained as a practical approach to facilitated patient’s adherence to the nutritional therapy. This model is currently implemented in most clinics of the country and gives considerable flexibility regarding variation in meal planning, food selection, amounts consumed, cooking methods as well as adaptations to day-to-day changes. Current LPD use in Sweden is presented through analysis of the Swedish Renal Registry. Finally two patient cases are illustrated, with examples on their diets, attempts to reduce the protein content to the desired thresholds and their clinical course.

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