6 patients in end-stage renal failure of varying aetiologies have been studied on low protein dietary regimens according to a P 6 formulation. All patients had part of their daily protein allowance substituted by an essential amino acid capsule also containing histidine and glutamic acid. All patients were maintained in nutritional balance as a result of the regimens prescribed. No toxic effects were noted and patient compliance was good. Our studies suggest the amino acid formulation given is safe and did not cause any fluctuations in patient plasma amino acid profiles. Our studies suggest an improved method of low protein dietary management for chronic renal failure patients together with a greater flexibility and wider range of prescribing possibilities. It is recommended that amino acid supplements according to the formula produced here constitute an improvement on currently prescribed Giovannetti regimens.

Low protein Giovannetti diets in three patients with chronic renal failure have been compared with isonitrogenous, iso-caloric amino acid tablet-substituted regimes. Another patient has been managed on such a regime after regular haemodialysis treatment had to be suspended. The amino acid diets proved palatable and were effective in maintaining nitrogen balance when the caloric supply was adequate. Improved nitrogen balance correlated with diminished faecal nitrogen excretion and falling or stable blood urea levels implying improved urea nitrogen re-utilization. It is suggested that when the caloric supply is adequate for generation of sufficient α-ketonic acid derivatives, ammonia nitrogen is preferentially utilized for the synthesis of non-essential amino acids rather than more urea formation. Metabolic acidosis is a potential hazard of such regimes.