VLIYaNIE MALOBELKOVOY DIETY, SBALANSIROVANNOY NEZAMENIMYMI KETO/AMINOKISLOTAMI I VYSOKOENERGETIChESKOY PITATEL'NOY SMES'Yu, NA PROGRESSIROVANIE POChEChNOY NEDOSTATOChNOSTI PRI DODIALIZNOY KhRONIChESKOY BOLEZNI POChEK, OBUSLOVLENNOY SISTEMNYMI ZABOLEVANIYaMI


Cite item

Full Text

Abstract

46 patients with III-IV staged CKD caused by systemic diseases (33 - by systemic lupus erythematosus and 13 - different systemic angiitis), were randomised to 3 groups: 1st - 18 patients (10 with III and 8 with IV stages) - during observational time (24-48 months) got LPD (0,6 g protein kg/day) with balanced content of essential amino- and ketoacids; 2 nd - 18 patients (10 with III and 8 with IV stages) - got LPD as well, but with increased level of plant protein till 0,3 g/kg/day owing to high-purity soy protein in the content of high-energetic nutrition mix; 3d - 10 patients (7 with III and 3 with IV stages) - control group - free diet. Both variants of LPD was prescribed to all patients of 1 and 2 groups without difference due to nutritional status. Nutritional status was evaluated on the basis of anthropometrical and some other standard parameters. Protein intake and food calories was counted according to 3-days food diery. Among 46 patients with systemic diseases and III-IV staged CKD nutritional status disorders were found almost at half (45,7%). Both variants of LPD were well tolerated, as a result of their use correction of nutritive disorders was achieved at patients that previously had them, and the prevention of nutritive disorders was got at the rest of the patients of 1 and 2 groups. In 3 group we found the increased frequency of nutritional status disorders with the progression of renal failure by 1,5 times (from 40% to 60%). At patients who took LPD not less than 1 year, we found slowing of GFR decrease, that was more significant with the use of high-energetic nutrition mix. Conclusion Early (at the stage before dialysis) protein intake constriction (0,6 g/kgг/day) with content in the diet of essential amino- and ketoacids and high-energetic nutrition mix has beneficial effects on nutritive status of patients with CKD and leads to slowing of GFR decrease

References

  1. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Am J Kidney Dis 2002;39(Suppl. 1).
  2. Klahr S, Levey AS, Beck GJ, et al. for the Modification of Diet on Renal Disease Study Group: The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med 1994;330:877-84.
  3. Kasiske BL, Lacatua JDA, Ma JZ, et al. A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis 1998;31:954-61.
  4. Милованов Ю.С. Хроническая почечная недостаточность. В кн.: "Рациональная фармакотерапия" / Под ред. Н.А. Мухина, Л.В. Козловской, Е.М. Шилова. М., 2006;13:586-601.
  5. Zakar G. The effect of ketoacid supplement on the course of chronic renal failure and nutritional parameters in predialysis patients and patients on regular dialysis theraphy: the Hungarian ketosteril cohort study. Wien Klin Wschr 2001;113:S686-S694.
  6. Walser M, Hill SB, Ward L, et al. A crossover comparison of progression of chronic renal failure: Ketoacids versus amino acids. Kidney Int 1993;43:933-39.
  7. Ермоленко В.М., Козлова Т.А., Михайлова Н.А. Значение малобелковой диеты в замедлении прогрессирования хронической почечной недостаточности // Нефрология и диализ. 2006. № 4. С. 310-320.
  8. Modification of Diet in Renal Disease (MDRD) Study Group (prepared by Levey A.S., Adler S., Caggiula A.W., England B.K., Grerne T., Hunsicker L.G., Kusek J.W., Rogers N.L., Teschan P.E.): Effects of dietary protein restriction on moderate renal disease in the Modification of Diet on Renal Disease Study. J Am Soc Nephrol 1996;7:2616-26.
  9. Modification of Diet on Renal Disease Study Group (prepared by Teschan P.E., Beck G.J., Dwyer J.T., Greene T., Klahr S., Levey A.S., Mitch W.E., Snetselaar L.G., Steinman T., Walser M.): Effect of ketoacid-amino acid-supplemented very low protein diet on the progression of advanced renal disease: A reanalysis of the MDRD feasibility study. Clin Nephrol 1998;501:273-83.
  10. Fouque D, Wang P, Laville M, et al. Low-protein diet delay end stage renal disease in non diabetic adults with chronic renal failure. NDT 2000;15:1986-92.
  11. Laouari D, kloinknecht C, Broyer M. Utilisation drs krtoanalodues d,acides amines dans l,insuffisance renale chronique. Nephrologie 1986;7:133-37.
  12. Милованов Ю.С., Козловская Л.В., Милованова Л.Ю. Нефропротективное значение ранней коррекции нарушений нутритивного статуса у больных с хронической болезнью почек на додиализном этапе // Терапевтический архив. 2008. № 6. С. 56-60.
  13. Мухин Н.А., Тареева И.Е., Шилов Е.М. Диагностика и лечение болезней почек. М., 2002. 381 c.
  14. Bergesio F, Monzani G, Guasparini A, et al. Cardiovascular risk factors in severe chronic renal failure: the role of dietary treatment. Clin Nephrol 2005;64:103-12.
  15. Mich W, Clark A. Specifity of the effect of leucin and its metabolites on protein degradation in skeletal muscle. Biochem J 1984;222:579-86.
  16. Duenbas M, Draibe S, Avesani C, et al. Influence of renal function on spontaneous dietary intake and on nutritional status of chronic renal insufficiency patients. Europ. J Clin Nutr 2003;57:1473-78.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies