Improved plasma amino acids pattern following 12 months of supplemented low-protein diet in peritoneal dialysis patients

Abstract

Background: Decreased plasma essential amino acid (EAA) levels, increased nonessential amino acid (NEAA) levels, and low EAA to NEAA ratio (E/NEAA) are common in peritoneal dialysis (PD) patients and may impact uremic complications. In the present study, we investigate the impact of keto acids-supplemented lowprotein (sLP) diet on plasma amino acids (AAs) patterns in stable PD patients. Methods: This is a supplemental analysis of a previously published prospective and randomized trial. Thirty-nine PD patients selected from the original population were divided to receive either low (LP: 0.6-0.8 g/kg ideal body weight [IBW]/d, n = 13), keto acids-supplemented low-(sLP: 0.6-0.8 g/kg IBW/d + 0.12 g/kg IBW/d of keto acids, n = 12), or high-(HP: 1.0-1.2 g/kg IBW/d, n = 14) protein diets and followed for 1 year. Plasma AA patterns were assessed at baseline and 12 months using high-performance liquid chromatography. Results: Whereas there were no significant differences between the three groups at baseline, following 12 months, the E/NEAA had increased significantly in group sLP (0.58 ± 0.16 to 0.83 ± 0.20, p < 0.05), but was not different in either LP (0.62 ± 0.20 to 0.72 ± 0.13, p = ns) or HP (0.66 ± 0.14 to 0.74 ± 0.12, p = ns) group. This change in E/NEAA in group sLP was due to a significant decrease in NEAA concomitantly with maintained EAA levels, whereas in the other two groups, neither EAA nor NEAA changed significantly. Conclusions: A low-protein diet supplemented with keto acids significantly improved the pattern of plasma AA in prevalent PD patients.

Low-Protein Diet Supplemented with Keto Acids Is Associated with Suppression of Small-Solute Peritoneal Transport Rate in Peritoneal Dialysis Patients

“…Since the current PD guidelines recommend high-protein intake of no less than 1.2 g/kg ideal body weight (IBW)/day [13], very few clinical practice could answer this question. Based on what we have found in our recent published paper [14, 15], DPI of 0.6–0.8 g/kg/d resulted in neutral nitrogen balance, maintained good nutritional status, and improved plasma amino acids pattern in PD patients if together with keto acid during 12 months of followup. We, therefore, further assessed the effect of dietary intervention on peritoneal transport rate by analyzing PET results at baseline and 12th month in the original PD cohort.…”

“…The study population and methodology have been previously described in detail [14, 15]. Briefly, 60 PD patients with residual renal function (urine output ≥800 ml/d or eGFR ≥2 ml/min/1.73 m 2 ) who fitted the inclusion criteria were enrolled and randomized to low- (LP: DPI of 0.6–0.8 g/kg IBW/d), keto-acid-supplemented low- (sLP: DPI of 0.6–0.8 g/kg IBW/d with keto acids of 0.12 g/kg IBW/d, Ketosteril; Fresenius Kabi Co., Ltd., Beijing, China), or high- (HP: DPI of 1.0–1.2 g/kg IBW/d) protein group in the original study.…”

Recurrent Disturbance of Consciousness in a Peritoneal Dialysis Patient with Severe Hypercalcemia Caused by Daily Low-Dose Keto Acids Supplementation

“…Keto acids are widely used in dialysis patients with end-stage renal disease [9,10]. The drug can effectively correct hypocalcemia, reduce blood PTH, elevate blood albumin and reduce blood phosphorus, so as to protect the patient's residual renal function.…”

Comparison of Intraperitoneal Amino Acid and Oral Amino Acid Supplements in Peritoneal Dialysis Patients

“…In spite of this, protein supplement appears to be a simple therapy that can be safely employed in protein energy wasting cases receiving CAPD, where it is tolerated [9]. Jiang et al reported that low protein diet combined with keto/amino acids significantly improved the pattern of plasma AAs in most patients receiving peritoneal dialysis [53]. In addition, a study by Boudville et al demonstrated that oral supplements, when taken before eating food, could improve caloric and protein intakes of PD patients significantly [54].…”