The use of ketoacids in chronic kidney disease


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

This review analyzes the large studies on the efficacy of the use of keto acids for the braking of chronic kidney disease (Ckd). The effect of keto acids on reduction of glomerular filtration rate was evaluated, the advantage of keto acids over essential amino acids was demonstrated. It is noted that the use of keto acids contributes to maintaining normal blood albumin levels and regression of protein-energy wasting and metabolic acidosis. It is concluded that the use of keto acids in the treatment of ckd patients contributes to a better control of risk factors associated with increased mortality.

Full Text

Restricted Access

About the authors

M. M. Batushin

Email: nephr-roon@rambler.ru

References

  1. Adey D., Kumar R., McCarthy J.T., Nair K.S. Reduced synthesis of muscle proteins in chronic renal failure. Am J Physiol Endocrinol Metab 2000; 278: 219-225.
  2. Aparicio M., Chauveau P., De Precigout V. et al. Nutrition and outcome on renal replacement therapy of patients with chronic renal failure treated by a supplemented very low protein diet. J Am Soc Nephrol 2000; 11(4): 708- 716.
  3. Aparicio M., Bellizzi V., Chauvean Ph. et al. Keto Acid Therapy in Predialysis Chronic Kidney Disease Patients: Final Consensus. J. of Renal Nutrition 2012; 22: 22-24.
  4. Barsotti G., Cupisti A., Barsotti M. et al. Dietary treatment of diabetic nephropathy with chronic renal failure. Nephrol Dial Transplant 1998; 13(Suppl 8): 49-52.
  5. Bellizzi1 V., Chiodini P., Cupisti A. et al. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort ontrolled study. Nephrol Dial Transplant 2015; 30: 71-77.
  6. de Brito-Ashurst I., Varagunam M., Raftery M.J., Yaqoob M.M. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol 2009; 20: 2075-2084.
  7. Brunori G., Viola B.F., Parrinello G. et al. Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am J Kidney Dis 2007; 49(5): 569-580.
  8. Chang J.H., Kim D.K., Park J.T. et al. Influence of ketoanalogssupplementation on the progression in chronic kidney disease patients who had training on low-protein diet. Nephrology (Carlton) 2009; 14: 750-757.
  9. Chauveau P., Couzi L., Vendrely B. et al. Long-term outcome on renal replacement therapy in patients who previously received a keto acid-supplemented very-low-protein diet. Am J Clin Nutr 2009; 90(4): 969-974.
  10. Cianciaruso B., Pota A., Bellizzi V. et al. Effect of a low- versus moderateprotein diet on progression of CKD: followup of a randomized controlled trial. Am J Kidney Dis 2009; 54: 1052-1061.
  11. Ciarambino T., Castellino P., Paolisso G. et al. Long term effects of low protein diet on depressive symptoms and quality of life in elderly Type 2 diabetic patients. Clin Nephrology 2012; 78: 122-128.
  12. Coresh J., Walser M., Hill S. Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis. J Am Soc Nephrol 1995; 6(5): 1379-1385.
  13. Fouque D., Laville M., Boissel J.P. et al. Controlled low protein diets in chronic renal insufficiency: meta-analysis. BMJ 1992; 304(6821): 216-220.
  14. Fouque D., Laville M., Boissel J.P. Low protein dietsfor chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev 2006; 2: CD001892.
  15. Garibotto G., Pastorino N., Dertenois L. Nutritional Management of renal diseases. Protein and amino acid metabolism in renal disease and in renal failure. In: Kopple J.D., Massry S., editors. USA: William and Wilkins; 2003; 20-32.
  16. Garibotto G., Sofia A., Saffioti S. et al. Amino acid and protein metabolism in the human kidney and in patients with chronic kidney disease. Clinical Nutrition 2010; 29: 424-433.
  17. Garibotto G., Sofia A., Saffioti S. et al. Effects of peritoneal dialysis on protein metabolism. Nutrition, Metabolism & Cardiovascular Diseases 2013; 23: 25-30.
  18. Ignace S., Fouque D., Arkouche W. et al. Preserved residual renal function is associated with lower oxidative stress in peritoneal dialysis patients. Nephrol Dial Transplant 2009; 24: 1685-1689.
  19. Di Iorio B.R., Bellizzi V., Bellasi A. et al. Phosphate attenuates the anti-proteinuric effect of very lowprotein diet in CKD patients. Nephrol Dial Transplant 2013; 28: 632-640.
  20. Jiang N., Qian J., Sun W. et al. Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. Nephrol Dial Transplant 2009; 24(8): 2551-2558.
  21. Klahr S., Levey A.S., Beck G.J. et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med 1994; 330(13): 877-884.
  22. Kovesdy C.P., Kopple J.D., Kalantar-Zadeh K. Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr 2013; 97:1163-1177.
  23. Koya D., Haneda M., Inomata S. et al. Low- Protein Diet Study Group. Long-term effect of modification of dietary protein intake on the progression of diabetic nephropathy: a randomized controlled trial. Diabetologia 2009; 52: 2037-2045.
  24. Lee P.D.K., Conover C.A., Powell D.R. Regulation and function of insulin-like growth factor-binding protein-1. Proc Soc Exp Biol Med 1993; 204(3): 4-29.
  25. Levey A.S., Adler S., Caggiula A.W. et al. Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study. Am J Kidney Dis 1996; 27: 652-663.
  26. Malvy D., Maingourd C., Pengloan J. et al. Effects of severe protein restriction with ketoanalogues in advanced renal failure. J Am Coll Nutr 1999; 18(5): 481-486.
  27. Masud T., Young V.R., Chapman T., Maroni B.J. Adaptive responses to very low protein diets: the first comparison of ketoacids to essential amino-acids. Kidney Int 1994; 45: 1182-1199.
  28. Meisinger E., Strauch M. The influence of two different essential amino acid/ keto analogue preparations on the clinical status of patients with chronic renal failure. Z Ernahrungswiss 1985; 24(2): 96-104.
  29. Menon V., Kopple J.D., Wang X. et al. Effect of a very lowprotein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. Am J Kidney Dis 2009; 53(2): 208-217.
  30. Mircescu G., Garneata L., Stancu S.H., Capusa C. Effects of a supplemented hypoproteic diet in chronic kidney disease. J Ren Nutr 2007; 17(3): 179-188.
  31. Mitch W.E., Walser M., Sapir D.G. Nitrogen sparing induced by leucine compared with that induced by its keto analogue, alpha-ketoisocaproate,in fasting obese man. J Clin Invest 1981; 67: 553-562.
  32. Pedrini M.T., Levey A.S., Lau J. et al. The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Ann Intern Med. 1996; 124(7): 627-632.
  33. Piccoli G.B., Deagostini M.C., Vigotti F.N. et al. Which low-protein diet for which CKD patient? An observational, personalized approach. Nutrition 2014; 30: 992-999.
  34. Pijls L.T., de Vries H., van Eijk J.T., Donker A.J. Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus: a randomized trial. Eur J Clin Nutr 2002; 56: 1200-1207.
  35. Prakash S., Pande D.P., Sharma S. et al. Randomized, double-blind, placebocontrolled trial to evaluate efficacy of ketodiet in predialytic chronic renal failure. J Ren Nutr 2004; 14(2): 89-96.
  36. Sallée M., Dou L., Cerini C. et al. The aryl hydrocarbon receptor-activating effect of uremic toxins from tryptophan metabolism: a new concept to understand cardiovascular complications of chronic kidney disease. Toxins (Basel) 2014; 6: 934-949.
  37. Sareen Gropper J.S. Advanced Nutrition and Human Metabolism. 6th ed. Belmont, CA: Wadsworth, Cengage Learning; 2012:194.
  38. Scalone L., Borghetti F., Brunori G. et al. Cost-benefit analysis of supplemented very low-protein diet versus dialysis in elderly CKD5 patients. Nephrol Dial Transplant 2010; 25(3): 907-913.
  39. Shah A.P., Kalantar-Zadeh K., Kopple J.D. Is There a Role for Ketoacid Supplements in the Management of CKD? Am J Kidney Dis. 2015; 65(5): 659-673.
  40. Simon E.E., Hamm L.L. A basic approach to CKD. Kidney Int. 2010; 77: 567-569.
  41. Smith M.B., March J. Advanced Organic Chemistry: Reactions, Mechanisms, and Structure.Hoboken, NJ: Wiley; 2001:503.
  42. Teplan V., Schuck O., Knotek A. et al. Enhanced metabolic effect of erythropoietin and keto acids in CRF patients on low-protein diet: Czech multicenter study. Am J Kidney Dis 2003; 41(3) (suppl 1): 26-30.
  43. Teschan P.E., Beck G.J., Dwyer J.T. et al. Effect of a ketoacidaminoacid-supplemented very low protein diet on the progression of advanced renal disease: a reanalysis of the MDRD feasibility study. Clin Nephrol. 1998; 50(5): 273-283.
  44. Walser M. Ketoacids in the treatment of uremia. Clin Nephrol. 1975; 3(5): 180-186.
  45. Wang D.T., Lu L., Shi Y. et al. Supplementation of ketoacids contributes to the up-regulation of the Wnt7a/Akt/p70S6K pathway and the down-regulation of apoptotic and ubiquitinproteasome systems in the muscle of 5/6 nephrectomised rats. Br J Nutr 2014; 111(9): 1536-1548.
  46. Walser M., LaFrance N., Ward L., VanDuyn M.A. Progression of chronic renal failure in patients given keto acids following amino acids. Infusionsther Klin Ernahrung 1987; 14(suppl 5): 17-20.
  47. Wesson D.E., Nathan T., Rose T. et al. Dietary protein induce endothelin-mediated kidney injury through enhanced intrinsic acid production. Kidney Int 2007; 71: 210-217.
  48. Williams B., Hattersley J., Layward E., Walls J. Metabolic acidosis and skeletal muscle adaptation to low protein diets in chronic uremia. Kidney Int 1991; 40: 779-786.
  49. Young V.R. Kinetics of human amino acid metabolism: nutritional implications and some lessons. McCollum Award Lecture. Am J Clin Nutr 1987; 46: 709-725.

Supplementary files

Supplementary Files
Action
1. JATS XML

This website uses cookies

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

About Cookies