High proportion of animal protein intake (>60% of total protein intake) is more effective than high vegetable diet in low protein diet for chronic renal failure (CRF) patients

The effects of a low-protein diet on the serum insulin-like growth factor (IGF)-1 and IGF binding proteins (IGFBP) were investigated during a 3-month controlled study in 12 adult chronic renal failure patients. Six patients were randomly supplemented with keto acids (Cetolog, Clintec, Velizy, France). Protein intake was prescribed so that both groups were isonitrogenous. Dietary survey included a monthly 3-day food record and a 24-h urinary urea measurement. After a 4- to 6-wk equilibrium period (1.11 g of protein, 32 kcal/kg body wt per day), patients reduced their protein intake to 0.71 g protein/kg body wt per day. Energy intake was kept constant (31 kcal/kg body wt per day) during the 3-month period. Serum IGF-1 levels were in normal range and, for 11 of the 12 patients, were correlated with the GFR (P = 0.01). These serum IGF-1 values did not decrease after reducing the protein intake. By Western ligand blotting, serum IGFBP1, IGFBP2, and IGFBP4 levels were significantly higher than normal adults, whereas the IGFBP3 level was not increased. IGFBP were not modified when protein intake was reduced. The IGFBP1 level was elevated despite a normal insulin level. IGFBP4 changes were inversely correlated with IGF-1 variations. There was no difference between groups receiving or not receiving the keto acids. Thus, in adult chronic renal failure, reducing protein intake by 40% did not modify the growth hormone/IGF-1/IGFBP axis.

Download Full-text

Adaptive Response to a Low-Protein Diet in Predialysis Chronic Renal Failure Patients

Journal of the American Society of Nephrology ◽

10.1681/asn.v1261249 ◽

2001 ◽

Vol 12 (6) ◽

pp. 1249-1254

Author(s):

JACQUES BERNHARD ◽

BERNARD BEAUFRÈRE ◽

MAURICE LAVILLE ◽

DENIS FOUQUE

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Energy Intake ◽

Protein Intake ◽

Protein Diet ◽

Metabolic Effects ◽

Low Protein Diet ◽

Controlled Study ◽

Food Record ◽

Low Protein

Abstract. A randomized, controlled study of 12 patients with mild chronic renal failure was designed to assess the metabolic effects of a low-protein diet supplemented (n= 6) or not (n= 6) with ketoanalogs of amino acids. The protein intake was prescribed so that both groups were isonitrogenous. The dietary survey each month included a 3-d food record and a 24-h urine collection for urea measurement. After a 4- to 6-wk equilibrium period (standard occidental diet, 1.11 g of protein and 32 kcal/kg per d), patients reduced their protein intake to reach 0.71 g of protein/kg per d during the third month. Energy intake was kept constant (31 kcal/kg per d) during the 3-mo period. Compliance to the diet was achieved after 2 mo of training. Leucine turnover measurement was performed before and at the end of the 3-mo low-protein period. There was no clinical change, whereas total body flux decreased by 8% (P< 0.05) and leucine oxidation by 18% (P< 0.05). No difference could be attributed to the ketoanalogs themselves. Thus, under sufficient energy intake, a low-protein diet is nutritionally and metabolically safe during chronic renal failure. The nitrogen-sparing effect of a low-protein diet is still present during mild chronic renal insufficiency.

Download Full-text

Comparison of a Vegetable-Based (Soya) and an Animal-Based Low-Protein Diet in Predialysis Chronic Renal Failure Patients

Nephron ◽

10.1159/000045021 ◽

1998 ◽

Vol 79 (2) ◽

pp. 173-180 ◽

Cited By ~ 56

Author(s):

N. Soroka ◽

D.S. Silverberg ◽

M. Greemland ◽

Y. Birk ◽

M. Blum ◽

...

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Protein Diet ◽

Low Protein Diet ◽

Low Protein ◽

Predialysis Chronic Renal Failure

Download Full-text

Forgotten Paths in Medicine: The Case of the Low Protein Diet in Chronic Renal Failure

Management of Medical Technology - Managing Technology in Healthcare ◽

10.1007/978-1-4613-1415-8_8 ◽

1996 ◽

pp. 155-187 ◽

Cited By ~ 1

Author(s):

David Ahlstrom ◽

Raghu Garud

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Protein Diet ◽

Low Protein Diet ◽

Low Protein

Download Full-text

Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis.

Journal of the American Society of Nephrology ◽

10.1681/asn.v651379 ◽

1995 ◽

Vol 6 (5) ◽

pp. 1379-1385

Author(s):

J Coresh ◽

M Walser ◽

S Hill

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Mortality Rate ◽

Serum Creatinine ◽

Dietary Treatment ◽

Mortality Rates ◽

Protein Restriction ◽

Protein Diet ◽

Low Protein Diet ◽

Low Protein

Concerns have been raised about the possibility of protein restriction resulting in malnutrition and poor subsequent survival on dialysis. However, no studies have examined patients treated with protein restriction to determine their subsequent survival on dialysis. This study prospectively monitored 67 patients with established chronic renal failure (mean initial serum creatinine of 4.3 mg/dL) who were treated with a very low-protein diet (0.3 g/kg per day) supplemented with either essential amino acids or a ketoacid-amino acid mixture and observed closely for clinical complications. Forty-four patients required dialysis. Once dialysis was started, dietary treatment was no longer prescribed. The cumulative mortality rate during the first 2 yr after starting dialysis was 7% (95% confidence interval, 0 to 16%). During this period, only two deaths occurred compared with 11.5 deaths expected on the basis of national mortality rates adjusted for age, sex, race, and cause of renal disease (P = 0.002). However, the protective effect was limited to the first 2 yr on dialysis. Thereafter, mortality rates increased, resulting in a total of 10 deaths during 96.4 person-years of follow-up, which was not significantly lower than the 14.9 deaths expected (P = 0.25). Extrapolation of sequential serum creatinine measurements made before dietary treatment suggests that the improved survival cannot be due to the early initiation of dialysis. Although the lack of an internal control group and data on dialysis lends uncertainty, the large difference in mortality rate between these patients and the nationwide experience indicates that protein restriction and close clinical monitoring predialysis does not worsen and may substantially improve survival during the first 2 yr on dialysis. These findings point out the importance of studying predialysis treatments as a means for lowering mortality on dialysis.

Download Full-text