Conservative Long-Term Treatment of Chronic Renal Failure with Keto Acid and Amino Acid Supplementation

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Abstract
In a group of 119 patients with advanced chronic renal failure (serum creatinine level 733 ± 186 μmol/l) the effect of a low-protein diet supplemented with essential amino acids (EAA) or their keto analogues (KA) on uremic metabolism and rehabilitation status was investigated. The protein intake amounted to 0.4 g/kg B.W./day, the phosphorus intake 0.4–0.6 g/day and the energy supply 120–150 kJ/kg B.W./day. In 51 patients there was a substitution with EAA and in 68 patients with their KA. The mean duration of dietary treatment in this study was 19 months (6–64 months). During this time, the serum creatinine increased from 733 + 186 to 1,220 ± 256 μmol/l, whereas the urea nitrogen values remained relatively constant at between 26 and 30 mmol/l. There were no signs of protein malnutrition (nitrogen balance, serum transferrin and serum protein were normal). The hemoglobin concentration remained at > 5 mmol/l with creatinine levels of 1,220 ± 256 μmol/l. During the substitution with KA, there was a significantly greater decrease in serum phosphate (p < 0.05) and parathyroid hormone (PTH) (p < O.01) as compared with the uremics given EAA. In addition, we found a significant increase in testosterone (p < O.Ol) in patients supplemented with KA. Despite advanced chronic renal failure there was a good degree of rehabilitation (full-time work: 21%; part-time work: 66.4%). It can be concluded that a low-protein diet supplemented with EAA or KA can improve the uremic metabolism, rehabilitation status and safely postpone the start of maintenance dialysis.

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