Original Communication
European Journal of Clinical Nutrition (2005) 59, 129–136. doi:10.1038/sj.ejcn.1602050 Published online 8 September 2004
Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients
Guarantor: L Cuppari.
Contributors: SFF was mainly responsible for the collection and analysis of the data. ACB, MRD and FBN were the renal dietitians who followed the patients during the study. RW was the physician responsible for the patients. SAD and LC were the coordinators of the research.
S F Feiten1, S A Draibe2, R Watanabe2, M R Duenhas1, A C Baxmann1, F B Nerbass1 and L Cuppari1,2
- 1Nutrition Program, Federal University of São Paulo, São Paulo, Brazil
- 2Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
Correspondence: L Cuppari, Rua Pedro de Toledo, 282, 04039-000, São Paulo, SP, Brazil. E-mail: lilian@dis.epm.br
Received 10 February 2004; Revised 19 July 2004; Accepted 4 August 2004; Published online 8 September 2004.
Abstract
Objective: To evaluate the effects on the nutritional and metabolic parameters of a very-low-protein diet supplemented with ketoacids (VLPD+KA) in comparison with a conventional low-protein diet (LPD) in chronic kidney disease (CKD) patients.
Design: Prospective, randomized, controlled clinical study.
Setting: Outpatient Clinic of the Nephrology Division of Federal University of São Paulo, Brazil.
Subjects: The study involved 24 patients with advanced CKD (creatinine clearance <25 ml/min) that were randomly assigned to either a VLPD+KA (VLPD+KA group, 12 patients) or to a conventional LPD with 0.6 g/kg/day (LPD group, 12 patients). The patients were followed for 4 months.
Results: Nutritional status was adequately maintained with both diets for the studied period. Protein intake and serum urea nitrogen decreased significantly only in the VLPD+KA group (from 0.68
0.17 to 0.430.12 g/kg/day, P<0.05; from 61.412.8 to 43.614.9 mg/dl, P<0.001; respectively). Ionized calcium did not change in the VLPD+KA group but tended to decrease in the LPD group. Serum phosphorus tended to decrease in the VLPD+KA group probably as a result of a significant reduction in dietary phosphorus (529109 to 373125 mg/day, P<0.05) associated to the phosphorus-binding effect of the ketoacids. No change in these parameters was found in the LPD group. Serum parathormone increased significantly only in the LPD group (from 241138 to 494390 pg/ml, P<0.01). The change in PTH concentration was negatively correlated with changes in ionized calcium concentration (r=-0.75, P=0.02) and positively correlated with changes in serum phosphorus (r=0.71, P=0.03) only in the LPD group.
Conclusion: This study indicates that a VLPD+KA can maintain the nutritional status of the patients similarly to a conventional LPD. Besides, an improvement in calcium and phosphorus metabolism and a reduction in serum urea nitrogen were attained only with the VLPD+KA. Thus, VLPD+KA can constitute another efficient therapeutic alternative in the treatment of CKD patients.
Sponsorship: This study was supported by CAPES, Oswaldo Ramos Foundation and Fresenius Kabi, Ltda.
Keywords:
chronic kidney disease, low protein diet, very low protein diet, ketoacids, nutritional status
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