CLINICAL STUDY OF THE EFFECTS OF LOW-PROTEIN DIET AND SUPPLEMENTED WITH α-KETOACIDS THERAPY ON NUTRITION STATUS AND RESIDUAL RENAL FUNCTION IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS(CAPD) PATIENTS

Abstract

It is critical to preserve residual renal function (RRF) in CAPD, as RRF is associated with lower morbidity and mortality. low- protein diet supplemented with α-keto acids was reported to have an important roles in delaying in follow-up period progression of renal failure and relieving malnutritional status in non-dialysis patients with chronic renal failure. We evaluate the effects on the nutritional status and RRF of a low-protein diet supplemented with α-keto acids on CAPD patients prospectively. Seventy eight CAPD patients who were randomly assigned to a low-protein diet supplemented with α-keto acid group(keto acid group,31 patients),low-protein diet group(LPD group,26 patients)and routine protein diet group(RPD group,21 patients)were investigated and followed up for one year. The nutritional parameters were measured, and examinations of residual renal function (RRF), Kt/v, clearance of creatinine (Ccr) and levels of serum amino acids, mean arterial pressure (MAP), peritoneal ultrafiltration(UF),residual urine volume(RUV) and the status of water-sodium retentio were performed. Compared to LPD group, serum levels of prealbumin(PA), transferrin (TRF) retinal binding protein (RBP) had a significant increment both in keto acid group and RPD group(P〈0.01),but there was no significance between these two groups(p〉0.05)□Compared to RPD group, There was an incremental tendency in albumin(Alb), total cholesterol(TC), triglyceride (TG), Triceps skinfoles (TSF),midarm riuscle circumference(MAMC),body mass index(BMI) in keto acid group, but no significance(p〉0.05)□The serum concentrations of Valine(Val),Leucine(Leu), Isoleucine (Ile) were significantly increased in keto acid group(p〈0.01),compared to the other groups. Levels of RRF, Kt/V, Ccr, RUV were significantly higher both in keto acid group and LPD group than in RPD group(p〈0.01)□There were no significant differences in MAP, UF and peritoneal dialysate albumin loss between these groups, However, the trend of peritoneal dialysate albumin loss in keto acid group and LPD group was descendent□ Proteinuria decreased most significantly in keto acid group (P〈0.01).In conclusion, Low-protein diet supplemented with α-keto acids therapy has a tendency of protecting RRF in CAPD patients while relieving malnutritional status and improving the 1evels of branched chain amino acids.