Can keto/amino acids reduce oxidative stress in peritoneal dialysis patients with hypoalbuminemia?

Abstract

Introduction There is no consensus on an ideal marker of oxidative stress (OS). Disruption of the balance between free radical and antioxidant activity production by increasing oxidative markers results in OS. In this study, we aimed to investigate how OS, which increases mortality and morbidity due to various reasons, is affected by keto/amino therapy in patients with hypoalbuminemia undergoing peritoneal dialysis. Materials and Method Twenty patients who underwent peritoneal dialysis were included in the study. Before starting keto/amino acid therapy, primary kidney diseases were determined, body mass indexes, serum total protein, albumin, C‐reactive protein, ferritin, calcium, phosphorus, parathyroid hormone, paraoxonase‐1 (PON‐1), sialic acid levels, arylesterase (ARE) activities, and malondialdehyde (MDA) levels were measured, and Kt/V values were calculated. Keto/amino acid treatment was initiated for those with an albumin level of <3.5 g/dL. The same parameters of the patients, followed up for 3 months, were checked again at the end of the third month. Results Paraoxonase‐1 and ARE activities, which are antioxidant enzyme activities, were found to be statistically significantly increased compared to the initial period (59 ± 59, 135 ± 69, 15.8 ± 19.7, and 44.7 ± 16.4, respectively; p < 0.00). MDA and sialic acid levels were significantly lower than the initial values (109 ± 99, 23 ± 9, 2.26 ± 0.44, and 2.04 ± 0.39, respectively; p < 0.01). Conclusion In our study, after the initiation of keto/amino acid treatment, PON‐1, which is a significant antioxidant marker, and ARE plasma activities increased and tissue destruction product MDA and sialic acid significantly decreased. In the light of all these data, we think that this treatment can reduce OS, improve hypoalbuminemia, which causes both mortality and morbidity in patients, improve survival in PD patients, and may be an antioxidant treatment in suitable patients.

Comparison of mortality according to baseline, first year, and mean albumin levels in peritoneal dialysis: a retrospective study

“…In addition to improving gastrointestinal symptoms after the removal of uremic toxins, nutritional intervention may play a role in ameliorating hypoproteinemia after PD. In addition, an increase in albumin levels has been shown to reduce oxidative stress, which is a risk factor for unconventional cardiovascular disease [ 18 ].…”

Effect of high-flux hemodialysis plus compound-α Ketoacid tablets under humanistic care on calcium-phosphorus metabolism in uremia patients

“…Furthermore, the combined use of compound-α ketoacid tablets can bind part of urea nitrogen to form necessary amino acids that help to inhibit the protein decomposition process in the body, thus alleviating metabolic acidosis and modulating amino acid metabolism. Moreover, Ca ions in the drug can bind to P ions in the body to lower the P content, thereby controlling iPTH secretion and achieving the purpose of regulating Ca-P metabolism [14]. On the other hand, UR patients have decreased renal and gastrointestinal function, which increases the difficulty of timely removal of gastrointestinal endotoxins and the consequent accumulation of endotoxins, resulting in a significant reduction in the intake of nutrients entering the body.…”