Oral essential aminoacid and ketoacid supplements in children with chronic renal failure (original) (raw)
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Evaluation of long-term aggressive dietary management of chronic renal failure in children
Pediatric Nephrology, 1990
Ten children with chronic renal failure (CRF) were managed for 3 years using a strict low-protein and low-phosphorus diet supplemented by a mixture of the keto and amino forms of the essential amino acids and histidine (phase II). All of these children were previously managed for at least 2 years with a less rigorous diet of limited protein intake with no specific reduction of phosphorus (phase I). Energy, vitamin D, bicarbonate, phosphate binders and vitamin and mineral mixtures were added as required during both dietary phases. Data on dietary intake showed a significant fall in protein and phosphorus intake and a rise in calcium intake during phase II compared with phase I. Plasma calcium increased and phosphate fell, with an associated fall in intact parathyroid hormone levels. There was a marked improvement in urea creatinine ratios, which suggested an improved anabolic state. Cholesterol and triglyceride levels were improved. Height and weight velocity were increased, becoming significant after 3 years of phase II. Renal function deteriorated at a slower rate than predicted. The diet was well tolerated by the children, with fitness and school performance showing improvement. We conclude that long-term strict dietary management of children with CRF is feasible. Our data suggest an overall improvement in general health and an apparent reduction in the rate of deterioration of renal function.
Nutritional status and muscle amino acids in children with end-stage renal failure
Kidney International, 1992
Nutritional status and muscle amino acids in children with end-stage renal failure. Nutritional status, assessed by anthropometric and biochemical methods, and muscle water, protein and amino acid composition, were evaluated in a control group of 10 children with normal renal function who were undergoing elective surgery, and in 15 children with end-stage chronic renal failure. Samples of the rectus abdominis muscle were taken when surgery was performed in the control children and when a peritoneal catheter was implanted in the uremic children. Height and body weight were reduced in the uremic children compared to the controls but skinfold thickness, arm muscle circumference and serum proteins (total protein, albumin, transferrin, pseudocholinesterase) were essentially normal. The muscle contents of total, extracellular and intracellular water, and of alkali-soluble protein (ASP), DNA and the ASP-DNA ratio were not significantly different in uremic children from those in the controls. Plasma leucine, isoleucine, tyrosine, valine, and serine levels were significantly decreased, whereas plasma citrulline, 1-methylhistidine and 3-methylhistidine levels were increased. Muscle isoleucine and valine levels and the valine/glycine ratio were low in the uremic children. Our results demonstrate that children with chronic renal failure and growth retardation may maintain a satisfactory nutritional status but exhibit amino acid abnormalities typical of ure-There are numerous reports concerning abnormal plasma amino acid (AA) concentrations in patients with chronic renal failure [1-3]. The plasma concentrations do not necessarily reflect the intracellular concentrations, and the determination of free AA in muscle, which is the largest pool of free AA in the body, is of particular interest in the study of AA metabolism in uremia. In untreated adult patients with chronic renal failure (CRF) a typical muscle intracellular AA pattern has been described [4, 5]. Intracellular AA abnormalities similar to those in adult patients have also been reported in children with CRF [6, 7]. The role of nutritional factors and of uremia itself in these abnormalities is still not clear. The aim of this study was to investigate plasma and muscle AA concentrations in relation to anthropometric and biochemical nutritional parameters in children with end-stage renal failure.
Pediatric Nephrology, 1994
This report describes growth and nutrition data from the feasibility phase of a clinical trial that was designed to evaluate the effect of diet protein modification in infants with chronic renal insufficiency (CRI). The purpose of the proposed trial was to compare the safety (effect on growth in length) and efficacy [effect on glomerular filtration rate (GFR)] of a diet with a low protein: energy (P: E) ratio versus a control diet in such patients. Twenty-four infants with GFRs less than 55 ml/min per 1.73 m 2 were randomly assigned at 8 months of age to receive either a low-protein (P : E ratio 5.6%) or control protein (P: E ratio 10.4%) formula, which resulted in average protein intakes
Nutritional status, protein intake and progression of renal failure in children
Pediatric Nephrology, 2006
Nutritional status and progression of renal failure in 35 children (22 males and 13 females; mean age: 8.85± 4.13 years) with moderate renal failure were followed for 2 years. All children were on an "ad libidum" diet. Protein intake was determined by a minimum of two dietary diaries kept by the parents and the appearance of urea nitrogen. The children were divided into two groups according to their protein intake: Group 1sub-optimal intake (46% of the children, all with significantly lower protein intake); Group 2adequate protein intake. The mean protein intake (expressed as a percentage of the WHO recommendations) based on the diets of the patients was 94.79% in Group 1 children and 175.45% in Group 2 children (p<0.05). All patients had a calorie intake of at least 80% of the WHO recommendations. Nutritional status was determined by anthropometric measurements expressed as a standard deviation score. There was no significant anthropometric or biochemical evidence of malnutrition in children with moderate chronic renal failure (CRF). The glomerular filtration rate (GFR) in patients with a sub-optimal intake of protein was −5.41±2.87 ml/2 year versus−9.53±8.61 ml/ 2 year in the normal protein intake group. There was no correlation between protein intake, nutritional status and progression of renal failure in children with moderate CRF within the 2-year study period.
Nutrition and growth in children with chronic renal insufficiency
opensigle.inist.fr
Estimation of progression of CRI 145 Discussion 158 Baseline results 164 Anthropometric evaluation and blood pressure 164 Nutrient intake 171 Biochemical variables 180 Longitudinal results and discussion of individuals 191 Patients Growth, other anthropometric indices, energy and 203 protein intakes Anthropometry 203 Energy and protein intakes Macronutrient intake and hyperlipidaemia Progression of CRI Plasma urea and electrolytes Blood pressure related to sodium intake Proteinuria Sodium, phosphorus and calcium intakes and bone 239 metabolism Anaemia and iron, folate and vitamin C intakes 248 Adherence to dietary advice 254 Energy 254 Protein 255 Sodium 256 Pho~horus 257 Calcium 258 Iron 259 Vitamin C 259 Biochemical assessment (plasma proteins) of 260 nutritional status 4.3.5 4.4
International Journal of Basic & Clinical Pharmacology, 2014
Background: The objective was to evaluate the efficacy and safety of α-keto analogs of essential amino acids (KAA) as a supplement in chronic kidney disease (CKD). Methods: A prospective comparative study was conducted in patients of CKD of a tertiary care center of North India. Patients were randomly divided into two interventional groups. Group I (control) was advised conservative management and placebo while Group II (KAA) given conservative management along with KAA (600 mg, thrice daily) for 12 weeks. Hemogram, renal function tests, lipid profiles were done, and adverse effects were recorded at 0, 4, 8, and 12 weeks of treatment. Results: There was progressive improvement in clinical features in both groups after 12 weeks of treatment, but KAA group showed more marked improvement as compared with the control group. Both groups showed gradual improvement in the biochemical parameters as compared to their pre-treated values, which was more marked in KAA supplemented 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. KAA group showed significant (p<0.05) improvement in lipid profiles as compared with the control group. There was no statistical difference in two groups with respect to side-effects (p>0.05). Conclusion: KAA supplementation along with conservative management is efficacious and safe in preventing the progression of disease in patients of CKD.
Optimizing Nutrition in Renal Patients: Effects of a Low-Protein Diet Supplemented With Ketoacids
Cureus
Background Chronic kidney disease (CKD) is a non-communicable disease; it is a major cause of morbidity and mortality in Nigeria as the incidence has been increasing in Nigeria over the last few years. A low-protein diet supplemented with ketoacids has been duly documented to reduce the malnutrition associated with CKD as well as improve estimated glomeruli filtration rate while delaying the onset of dialysis in predialysis CKD patients. Objective The aim of this study was to determine the effects of a low-protein diet supplemented with ketoacids compared to a conventional low protein on nutritional indices in predialysis CKD patients. Methods and materials A randomized controlled trial with a total of 60 participants was conducted at Delta State University Teaching Hospital (DELSUTH), Oghara, Nigeria. Participants were patients older than 18 years with CKD stage 3-5 who were not on dialysis. They were recruited and randomized into the intervention group (lowprotein diet supplemented with ketoacids) with 30 participants and the non-intervention group (low protein with placebo) with 30 participants. The mean outcome was changed in the nutritional indices from baseline till the end of the study. Results A total of 60 patients were randomly allocated to receive a low-protein diet supplemented with ketoacids (n=30) or control (n=30). All participants were included in the analysis of all outcomes. The mean change score in serum total protein, albumin, and triglycerides between the intervention and non-intervention groups were 1.1±1.1 g/dL vs 0.1±1.1 g/dL (p<0.001), 0.2±0.9 g/dL vs-0.3±0.8 g/dL (p<0.001), and 3.0±3.5 g/dL vs 1.8±3.7 g/dL, respectively. Conclusion and recommendation The use of low-protein diet supplemented with ketoacids improved the anthropometric and nutritional indices in patients with stage 3-5 CKD.