Clinical experience with amino acid and keto acid diets

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Abstract
A diet containing about 18 g of mixed protein supplemented with essential amino acids or keto acids has been used as an alternative to dialysis for long-term treatment of 68 patients (mean age, 56 years) with end-stage renal failure (mean creatinine clearance, 4.8 ml/min at the beginning of treatment). After institution of the dietary regimen, serum urea and serum urea/creatinine ratio decreased, while serum creatinine increased slowly due to progression of the underlying renal disease. Serum albumin and transferrin were unchanged and no progression of peripheral neuropathy was observed. The patients were treated for 30 to 840 days (mean, 215 days) before they were dialyzed or received a kidney transplant. Seven elderly patients (mean age, 68.9 years) who were considered not suitable for active treatment for medical reasons, died after an average of 326 days on treatment with the diet. The 3-year cumulative survival in all 68 patients was 68%, which is well at level with the survival rates of patients treated with dialysis or renal transplantation, especially considering the high mean age of our patients. The cumulative 3-year survival after exclusion of seven patients not accepted for active treatment and 17 transplanted patients was 86%. We conclude that treatment with an 18-g protein diet plus essential amino acids can considerably extend the period of conservative treatment and postpone the start of regular dialysis without endangering life expectancy of the patients.

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