The role of dietary protein restriction supplamented with alpha-keto analogs of essential amino acids on prevention of progression and complications of disease in patients with chronic renal failure

The role of Dietary Protein Restriction Supplamented with Alpha-Keto Analogs of Essential Amino Acids on Prevention of Progression and Complications of Disease in Patients with Chronic Renal FailureAim: Chronic renal failure is a progressive disease. The progression rate and complications of the disease may decrease with protein restricted diet in patients with renal disease. The use of alpha keto analogs of essential amino acids may control more effectively the damaged metabolic parameters. We planned to investigate the role of protein restricted diet supplamented with alpha keto analogs of essential amino acids on prevention of progression and complications of disease in patients with chronic renal failureMaterial and Methods: We included 72 patients (43 male, 29 female) with grade 3-4 renal disease. Dietary protein was restricted to 0.6 g/kg/day for all study group. The patients divided into two groups. 36 patients were undertaken only protein restricted diet and the others(36 patients ) were undertaken protein restricted diet supplamented with 5 mg/kg/day keto analogs of essential amino acids. Glomerular filtration rate, proteinuria, anemia, renal osteodystrophy and metabolic acidosis were followed by one year in two groups. In the course of the study one patient died due to acute myocard enfarction, 1 patient died after coronary by-pass operation, 15 patients were excluded due to incompatibility of the diet, 6 patients started haemodialysis, 3 patients were excluded due to not attending controls regularly. The study was completed with 46 patients(25 male, 21 female). 26 patients were taking diet and keto analogs and 20 patients were on low protein diet onlyResults: At the following course, dietary protein was 0,72±0,04 g/kg/day and 0,73±0,05 g/kg/day in keto analog group and in low protein diet group,. The creatinin clerence in keto analog group increased (Beginning: 30±8,2 mL/min End: 37±9,1 mL/min ) in the following course. The creatinin clearence in protein restricted group decreased(Beginning: 39,8±13,2 mL/min End: 33,1±8,5 mL/min) during the course. (Pdrug : 0,032) The decrease of the level of phosphorus in keto analog group( Beginning: 4,02±0,67 mg/dL End: 3,62±0,51 mg/dL) was more prominent than protein restricted group (Beginning: 3,83±0,77 mg/dL End: 3,79±0,62 mg/dL ),(Pdrug : 0,022). The value of haemoglobin in keto analog group(Beginning: 12,55±1,95 g/dL End: 12,36±1,77 g/dL) was better than protein restricted group (Beginning: 11,63±2,01 g/dL End: 11,00±1,93 g/dL), (Pdrug : 0,030 ). In keto analog group proteinuria, systolic and diastolic blood pressure, serum bicarbonate, alkaline phosphatase values were significantly better than protein restricted group in the course of study.( Ptime:0,001, Ptime:0,001, Ptime:0,015, Ptime:0,001, Ptime:0,034). Albumin values in keto analog group did not change. But in protein restricted group we found minimal decrease in albumin levels( Ptime:0,069). In two groups the serum levels of total cholesterol, low density lipoprotein, high density lipoprotein, triglyserid, lipoprotein a, C-reactive protein, ferritin, üric acid decreased to normal levels at the end of the studyDiscussion: Protein restriction with the use of alpha keto analogs of essential amino acids in patients with chronic renal failure has positive effects on glomerular filration rate, anemia, asidosis, calcium-phosphorus metabolism and blood pressureKeysword: Chronic renal failure, protein restriction, alpha keto analogs of essential amino acids, proteinuria, creatinin clerance