Amino Acid Therapy for Patients with Chronic Renal Failure

Abstract

Conservative therapy in advanced chronic renal failure is based on low-protein diet. Precautions have to be taken so that the patient does not develop protein deficiency. By supplementing low-protein diets with essential amino acids orally (as tablets) this risk can be minimized. Uremic patients have specific requirements for some amino acids which can be fulfilled by modifying the composition of the amino acid preparation. By supplementing a low-protein diet (–0.3 g protein/kg B.W./day) with an amino acid mixture which contains proportionally more valine and less leucine and isoleucine than prescribed by the Rose formula and, in addition, histidine and tyrosine. the amino acid abnormalities in plasma and muscle can be improved and nitrogen equilibrium maintained.

Factors Contributing to Catabolism in End-Stage Renal Disease Patients

“…16. ] mal, with low concentrations of most essential amino acids and high concentrations of some nonessential amino acids [26]; this pattern is similar in many respects to that observed in individuals suffering from protein malnutrition.…”

“…Muscle amino acid concentrations do not necessarily reflect plasma levels [27] Typical changes in the muscle of ESRD patients with untreated chronic uremia are low intracellular concentrations of valine, threonine, lysine, histidine, and tyrosine [26]; in dialysis patients, most of these deficiencies normalize. Noticeably, muscle intracellular valine depletion occurs even in apparently wellnourished HD patients.…”

“…Low plasma tyrosine and a low ratio of tyrosine to phenylalanine in plasma and muscle [26] may be due to reduced activity of phenylalanine hydroxylase in the uremic state [30] and especially to a reduction in the renal cell mass, where a large part of the conversion of phenylalanine to tyrosine normally takes place [31]. Low plasma serine (and in hemodialysis patients, low muscle serine) and high glycine levels [26] may be due to reduced renal conversion of glycine to serine [31], since the kidney is the major endogenous source of serine under normal conditions [32].…”

“…Low plasma serine (and in hemodialysis patients, low muscle serine) and high glycine levels [26] may be due to reduced renal conversion of glycine to serine [31], since the kidney is the major endogenous source of serine under normal conditions [32]. It is still an open question whether the aforementioned amino acid abnormalities are detrimental in ESRD patients and need to be corrected.…”

A practical approach to low protein diets in Sweden– 45 years of clinical use

“…A Swedish group led by the late Professor Jonas Bergström at Karolinska Institutet in Stockholm [ 2 ], decided to explore the possibility of improving the quality of the low protein diet by supplementing it with essential L-amino acids. They showed that nitrogen balance was neutral or even positive with the use of amino acid (AA) solutions containing the 8 essential amino acids (EAA) and histidine compared to solutions containing only the 8 EAA [ 3 , 4 ].…”