Ketoanalogues Of Amino Acids Research Articles

Ketoanalogues Supplemental Low Protein Diet Safely Decreases Short-Term Risk of Dialysis among CKD Stage 4 Patients.

Background: Rigid dietary controls and pill burden make a very-low protein (0.3–0.4 g/kg body weight per day), vegetarian diet supplemented with ketoanalogues of amino acids (sVLPD) hard to follow in the long-term. This study aimed to evaluate whether a ketoanalogue supplemental low-protein diet (sLPD) (0.6 g/kg body weight per day) could also reduce the risks of dialysis among CKD stage 4 patients. Methods: Patients aged >20 years with a diagnosis of stage 4 CKD who subsequently received ketosteril treatment, which is the most commonly used ketoanalogue of essential amino acids, between 2003 and 2018 were identified from the Chang Gung Research Database (CGRD). Then, these individuals were divided into two groups according to the continuation of ketosteril for more than three months or not. The primary outcome was ESKD requiring maintenance dialysis. Results: With one-year follow-up, the continuation group (n = 303) exhibited a significantly lower incidence of new-onset end-stage kidney disease (ESKD) requiring maintenance dialysis (6.8% vs. 10.4%, hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.41–0.94) in comparison to the discontinuation group (n = 238). Conclusions: This study demonstrated that initiating sLPDs since CKD stage 4 may additionally reduce the short-term risks of commencing dialysis without increasing CV events, infections, or mortality.

Nutritional support for patients with chronic kidney disease at pre-dialysis stages

Chronic kidney disease (CKD) is characterized by poor outcomes, an increasing frequency of new cases, the need for expensive method of renal replacement therapy at the terminal stage. The main task facing the doctor is slowing the progression of CKD and delay the start of dialysis by applying the nephroprotective strategy, of which diet therapy is an essential part. The key components of the diet for CKD patients are reducing sodium intake to 2.3 g per day in order to improve control of blood pressure (BP), dietary protein restriction adequate to renal function from 0.8 to 0.3 g/kg of body weight per day combined with the prescribing of ketoanalogues of essential amino acids, hyperglycemia control. With the progression of CKD, the main objectives of the diet therapy are the prevention/correction of complications: protein-energy waisting, metabolic acidosis, ensuring sufficient calories, corresponding to the bodys energy expenditures (3035 kcal/kg of body weight per day), limiting phosphate intake to 0.81 g a day, restriction of food potassium. Low-protein diet in combination with ketoanalogues of amino acids, regular monitoring and correction of the nutritional status of patients at the pre-dialysis stages of CKD is an effective and safe method of nephroprotection, which allows delaying the start of dialysis.

Efficiency of post-dilution online hemodiafiltration therapy in combination with ketoanalogues of amino acid in the correction of protein-energy malnutrition in hemodialysis patients

Purpose of the study. Evaluate the efficiency of permanent post-dilution online hemodiafiltration therapy in combination with the prescription of keto analogues of amino acid at a dose of 0,2 g/kg of ideal body weight/day to correct protein-energy malnutrition in hemodialysis patients with adequate intake of essential nutrients. Patients and methods. A total of 645 patients with terminal renal failure received programmed hemodialysis, of which there were 300 men and 345 women aged 58,8 ± 6,9 years. All patients received treatment with programmed GD for 6,9 ± 2,1 years. All patients underwent a comprehensive assessment of nutritional status. The level of leptin and interleukin-6 serum was determined. Patients with signs of protein-energy malnutritian (PEM) were divided into three groups, depending on the method of PEM correction. Results. The study showed the efficiency of postdilution online hemodiafiltration therapy on an ongoing basis in combination with keto-analogues of amino acids at a dose of 0,2 g/kg of ideal body weight/day for correction of PEM in hemodialysis patients. Conclusion. The post-dilution online hemodiafiltration therapy combined with keto-analogues of amino acid at a dose of 0.2 g /kg of ideal body weight/day can be considered one of the pathogenetically grounded methods for correcting PEM in patients receiving programmed hemodialysis with adequate intake of essential nutrients.

Régime pauvre en protéines supplémentés par les céto-analogues des acides aminés chez le patient atteint d’insuffisance rénale : pour qui ? Comment ?

Restricted protein diets in patients with chronic kidney disease have been debated for several decades. In chronic kidney disease as in other chronic diseases, the modulation of the nutritional intake is the object of a certain renewal. It is supported by recent studies that highlight the importance of modulating nutrient intake by diets that are healthier, less rich in animal proteins and richer in plants. The recent reintroduction in France of amino acid supplements and ketoanalogs of amino acids allows the prescription of a very restricted diet. Historical studies have only focused on the relationship between protein intake and renal function degradation. Recent studies on acid loading, bone metabolism or potassium intake allow revisiting the interest of restricted diets. As with any change in eating habits, the selection of patients, information, education and monitoring during the diet are very important and help prevent undernutrition: this is the purpose of this short review.

Ketoanalogues of aminoacids in chronic kidney disease

Ketoanalogues of aminoacids in chronic kidney disease

Effect of Dietary Protein Intake on Serum Total CO2 Concentration in Chronic Kidney Disease

Metabolic acidosis is a feature of chronic kidney disease (CKD), but whether serum bicarbonate concentration is influenced by variations in dietary protein intake is unknown. For assessing the effect of diet, data that were collected in the Modification of Diet in Renal Disease study were used. In this study, patients with CKD were enrolled into a baseline period, then randomly assigned to follow either a low- or a usual-protein diet (study A, entry GFR 25 to 55 ml/min) or a low- or very low-protein diet, the latter supplemented with ketoanalogs of amino acids (study B, entry GFR 13 to 24 ml/min). Serum [total CO2] and estimated protein intake (EPI) were assessed at entry (n = 1676) and again at 1 yr after randomization, controlling for changes in GFR and other key covariates (n = 723). At entry, serum [total CO2] was inversely related to EPI (1.0 mEq/L lower mean serum [total CO2]/g per kg body wt increase in protein intake/d; P = 0.009). In an intention-to-treat analysis, the reduction in mean EPI in the low-protein group as compared with the usual-protein group (0.41 g/kg body wt per d) was independently associated with a 0.9-mEq/L increase in serum [total CO2], after adjustment for covariates (P < 0.001). No such effect was evident in study B, in which the very low-protein diet group received dietary supplements. Serum [total CO2] is inversely correlated with dietary protein intake in patients with CKD. A reduction in protein intake results in an increase in serum [total CO2].

Effect of rhatannin on glutamine metabolism in rat liver.

The present investigation was undertaken to evaluate the effect of rhatannin (condensed tannin purified form Rhei rhizoma) on transamination from glutamine by measuring the individual amino acids formed from α-keto analogues of amino acids with glutamine or glutamane or glutamate in the supernate of rat liver homogenate. Increased glycine formation was observed 2 to 4h after the intraperitoneal administration of rhatannin (12.5mg/kg body weight). Glutamate (derived from glutamine via glutaminase) may not participate in the rhatannin-induced elevation of glyoxylate amination by glutamine. This effect by rhatannin was completely abolished by cycloheximide treatment 30 min prior to rhatannin treatment, while actinomycin D had no effect. With 20 mM glutamine as the amino-donor, the order of effectiveness of 20 mM keto analogues of amino acids was glyoxylate>pyruvate>hydroxypyruvate>phenylpyruvate>α-ketoisocaproate, and little activity was observed with α-ketoisovalerate. Phenylalanine and leucine production rates were enhanced with either glutamine or glutamate in rhatannin-treated rats.The results of the present investigation suggest that the hepatic glutamine transaminase pathway might be enhanced in rhatannin-treated rats. This enhancement might be associated with a protein synthesis process.

Parenteral nutrition: current status and concepts.

Parenteral nutrition is regarded as a form of nutrition in some countries and as an extension of intravenous fluid therapy in others. The optimum clinical application of parenteral nutrition as a form of therapy requires detailed knowledge of the nutrient solutions themselves, including the commonly used solutions such as dextrose, soybean oil emulsion, synthetic crystalline L-amino acid solutions; older solutions such as xylitol, protein hydrolysates; and newer solutions such as glycerides and special purpose amino acid solutions. Additionally, information has accumulated over the past 10 years, leading to the rational use of vitamins and trace elements in parenteral nutrition. Metabolism of the substrates has been correlated with known pathways of intermediary metabolism in normal, starved and stressed subjects. Several new concepts have arisen: a) Infusion of excessive quantities of dextrose results in lipogenesis and increased carbon dioxide production. Hyperalimentation of this type is being replaced by infusion of lesser quantities of dextrose, supplemented by intravenous infusion of lipid as a calorie source. b) Protein hydrolysates and racemic synthetic crystalline amino acid solutions have been replaced by synthetic crystalline L-amino acid solutions. c) A new fat emulsion based on safflower oil is competing successfully with the traditional soybean oil emulsion. d) Newer substrates are being explored. These include branched chain amino acids, keto analogues of amino acids, synthetic glycerides and maltose. e) Deficiencies of essential fatty acids, trace elements and vitamins have been studied in patients on long term parenteral nutrition and their mechanisms elucidated. Official recommendations for intravenous administration of these nutrients have been made. f) Several techniques have been applied in several circumstances, including protein sparing therapy, cyclic nutrition, home therapy, and parenteral nutrition in liver and renal failure. Parenteral nutrition is now used extensively, not only in major hospitals where the resources of a team approach with physician, nurse, pharmacist and dietitian are available, but also in smaller hospitals where all of these facilities may not be at hand. However, whatever the setting, the principles behind the clinical application of parenteral nutrition should be well understood by those involved, including current approaches to safe preparation and infusion of parenteral nutrition solutions.

Stimulation of albumin synthesis by keto analogues of amino acids

1. (1) The effect of ketoanalogues of branched-chain amino acids on albumin synthesis was examined in two biological systems using the [ 14C]carbonate technique. 2. (2) α-Ketocaproic acid, the ketoanalogue of leucine, was able to reverse the reduced synthesis rate observed when isolated livers, from well-nourished animals were perfused with blood from rats deprived of dietary protein for 48 h. 3. (3) A mixture of ketoanalogues of the three branched-chain amino acids, leucine, isoleucine and valine, was able to increase albumin synthesis per unit dry liver weight to above normal levels when administered intragastrically to rats 16 h after partial hepatectomy.