The effect of a keto acid-amino acid supplement to a restricted diet on the progression of chronic renal failure.

  title={The effect of a keto acid-amino acid supplement to a restricted diet on the progression of chronic renal failure.},
  author={William E. Mitch and Mackenzie Walser and Theodore I. Steinman and S B Hill and Scott L. Zeger and Kriang Tungsanga},
  journal={The New England journal of medicine},
  volume={311 10},
We treated 24 patients who had chronic renal failure with a low-phosphorus diet containing 20 to 30 g of mixed-quality protein, supplemented by amino acids and their keto analogues. Seventeen patients had well-defined rates of progression before treatment, as assessed by serial determinations of serum creatinine levels. By extrapolating these rates of progression, we found that 10 of the 17 (59 per cent) had a clinically important slower rise in creatinine levels during long-term treatment… 
Progression of chronic renal failure on substituting a ketoacid supplement for an amino acid supplement.
The results suggest that this ketoacid supplement slows progression by approximately half, compared with an essential amino acid supplement, with no change in diet.
Progression of chronic renal failure in patients given ketoacids following amino acids.
This ketoacid supplemented regimen apparently halted the progression of moderately-severe chronic renal failure for at least a year in a small group of patients in whom restriction of protein and phosphate intake without ketoacids failed to halt progression.
[The effect of low-protein diet supplemented with ketoacids in patients with chronic renal failure].
Low-protein diet supplemented with ketoacids was effective in slowing progression of chronic renal failure, decreased PTH, did not change nutritional status, and with permanently and good education it was possible to keep patients on low- protein diet for a long period.
The risks and benefits of a low protein-essential amino acid-keto acid diet.
A very low protein diet supplemented by an essential amino acid-keto acid mixture may slow the decline in renal function in a proportion of patients, but muscle mass can be lost and a fall in plasma creatinine may not be due to improved GFR but instead to altered Creatinine metabolism.
Effect of amino acid, ketoacid supplementation to a low-protein diet on diabetic nephropathy with chronic renal failure
Type 1 diabetics with ‘overt’ diabetic nephropathy (DN) have a rapid decline of GFR, reaching the uremic status within a few months or years, and the daily insulin requirement was reduced despite the very high carbohydrate intake.
A crossover comparison of progression of chronic renal failure: ketoacids versus amino acids.
It is concluded that KA slow progression, relative to AA, independently of protein or phosphorus intake, in patients on this regimen is concluded.
Effect of Low-Protein Diet Supplemented with Keto Acids on Progression of Disease in Patients with Chronic Renal Failure
Accessible online at: Dear Sir, Dietary intervention is one of the major components of conservative therapy in patients with chronic renal failure (CRF). Various diet
Effects of a Supplemented Very Low Protein Diet in Predialysis Patients on the Serum Albumin Level, Proteinuria, and Subsequent Survival on Dialysis
  • M. Walser
  • Medicine, Biology
    Mineral and Electrolyte Metabolism
  • 1997
It is shown that when nephrotic patients are given this regimen, they rarely exhibit hypoalbuminemia, in contrast to the reported 25–50% hypo Albuminemia at the onset of dialysis nationwide, and their survival for the first 2 years on dialysis is much improved, in comparison with the national experience, adjusted for age, sex, and cause of renal disease.
Adaptive responses to very low protein diets: the first comparison of ketoacids to essential amino acids.
Eight patients with chronic renal failure (GFR 18.8 +/- 2.7 ml/min) were randomized to a crossover comparison of a very low protein diet (VLPD) containing 0.28 g protein and 35 kcal per kg per day,
The role of keto acids in the supportive treatment of children with chronic renal failure
The aim of this study is to investigate the efficacy and applicability of conservative therapy with a protein-restricted diet supplemented with keto acids in the management of chronic renal insufficiency or failure.


Long-term effects of a new ketoacid-amino acid supplement in patients with chronic renal failure.
It is concluded that this specially designed supplement added to a 20 to 25 g/d protein diet is an acceptable regimen which can improve or maintain protein nutrition in patients with severe chronic renal failure who would otherwise require dialysis.
Comparison of the effects of keto acid analogues and essential amino acids on nitrogen homeostasis in uremic patients on moderately protein-restricted diets.
It is concluded that any beneficial effects of keto acids in patients with chronic renal failure are only likely to occur in those taking a diet of less than 30 g protein daily.
Clinical results of long-term treatment with a low protein diet and a new amino acid preparation in patients with chronic uremia.
The results show that nitrogen equilibrium can be maintained during long-term treatment with this regimen and suggest that better nitrogen utilization is achieved with the new amino acid preparation than when essential amino acids are given to uremic patients in the proportions considered optimal for normal man.
Effects on renal function of a low-nitrogen diet supplemented with essential amino acids and ketoanalogues and of hemodialysis and free protein supply in patients with chronic renal failure.
In the third group of uremics on repeated dialysis therapy, the deterioration of creatinine clearance was markedly accelerated and the possible explanations and the practical implications of these findings are discussed.
Evaluation of essential amino acids and keto acids in uremic patients on low-protein diet.
Protein metabolism, as judged by serum transferrin, Clq, C3c, total complement activity, was improved and the concentrations of prealbumin and retinol-binding protein showed a further increase that might favor a vitamin A intoxication in chronic uremic patients.
Oral essential aminoacid and ketoacid supplements in children with chronic renal failure.
A protein-restricted diet supplemented with essential aminoacids and calcium-keto and hydroxyacids may be useful to improve linear growth and nutritional status in children with chronic renal failure, and that a reduction in hyperparathyroidism may be partly responsible for some of the beneficial effects observed.
Efficacy of an unselected protein diet (25 g) with minor oral supply of essential amino acids and keto analogues compared with a selective protein diet (40 g) in chronic renal failure.
In patients with a creatinine clearance less than 10 ml/min, the keto analogue supplementation led to an improvement of the uremic intoxication and the nutritional state, and in patients with chronic renal insufficiency, the essential amino acid supplementations showed no advantages over the standard diet.
Effects of dietary protein and phosphorus restriction on the progression of early renal failure.
It is concluded that a moderate dietary restriction of protein and phosphorus is an acceptable and effective regimen for delaying progression of functional deterioration in early renal failure.
Ketoacids in the treatment of uremia.
When KA were given after EAA, urea appearance fell and N balance improved, and when EAA were give after KA (5 studies), Urea appearance and N Balance did not worsen significantly during the 4-9 days of observation.