scholarly journals The value of a low-protein diet and ketoanalogues of essential amino acids in the сontrol of protein carbamylation and toxic effects of urea in chronic kidney disease

2021 ◽  
Vol 93 (6) ◽  
pp. 729-735
Author(s):  
Nataliia A. Mikhailova
Keyword(s):  
Chronic Kidney Disease ◽  
Amino Acids ◽  
Kidney Disease ◽  
Essential Amino Acids ◽  
Cardiovascular Complications ◽  
Uremic Toxins ◽  
Protein Diet ◽  
Toxic Effects ◽  
Low Protein Diet ◽  
Low Protein

Chronic kidney disease (CKD) is characterized by high mortality from cardiovascular diseases, the development of which is facilitated by traditional risk factors (typical for the general population) and by nontraditional ones (specific to patients with CKD) as well. These factors include also uremic toxins, for which a causal relationship has been established with specific pathological processes in patients with CKD, comprising the development of vascular dysfunction and accelerated progression of atherosclerosis. Urea has long been considered not as a uremic toxin, but as a marker of metabolic imbalance or dialysis efficiency (Kt/V) in CKD patients. In recent years, more and more publications have appeared on the study of the toxic effects of urea with the development of toxic-uremic complications and the phenotype of premature aging, common in CKD. It was found that an increase in urea levels in uremic syndrome causes damage to the intestinal epithelial barrier with translocation of bacterial toxins into the bloodstream and the development of systemic inflammation, provokes apoptosis of vascular smooth muscle cells, as well as endothelial dysfunction, which directly contributes to the development of cardiovascular complications. The indirect effects of increased urea levels are associated with carbamylation reactions, when isocyanic acid (a product of urea catabolism) changes the structure and function of proteins in the body. Carbamylation of proteins in CKD patients is associated with the development of renal fibrosis, atherosclerosis and anemia. Thus, urea is now regarded as an important negative agent in the pathogenesis of complications in CKD. Studies on a low-protein diet with using ketoanalogues of essential amino acids to minimize the accumulation of urea and other uremic toxins demonstrate the clinical benefit of such an intervention in slowing the progression of CKD and the development of cardiovascular complications.

Economic Effects of Treatment of Chronic Kidney Disease with Low-Protein Diet

2013 ◽  
Author(s):  
Francesco Saverio Mennini ◽  
Simone Russo ◽  
Andrea Marcellusi ◽  
Giuseppe Quintaliani ◽  
Denis Fouque
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Economic Effects ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals SP400VERY LOW PROTEIN DIET REDUCES SERUM LEVELS OF INDOXYL SULFATE AND P-CRESYL SULFATE IN CHRONIC KIDNEY DISEASE

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii253-iii253 ◽  
Author(s):  
Maria Teresa Rocchetti ◽  
Carmela Cosola ◽  
Ighli di Bari ◽  
Lucia Di Micco ◽  
Emanuele De Simone ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Levels ◽  
Indoxyl Sulfate ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease

2020 ◽  
Author(s):  
Kamyar Kalantar-Zadeh ◽  
Shivam Joshi ◽  
Rebecca Schlueter ◽  
Joanne L. Cooke ◽  
Amanda Brown-Tortorici ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Risk ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Uremic Toxin ◽  
Functional Impairments ◽  
Ckd Progression ◽  
Meat Intake ◽  
Low Protein

Chronic kidney disease (CKD) affects >10% of the adult population. Each year approximately 120,000 Americans develop end-stage kideny disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6-0.8 g/kg/day comprised of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, can be promising. The scientific premise of the PLADO is based on the observations that high protein diets with high meat intake are not only associated with higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of hyperkalemia, given constipation from the typical low fiber intake. Plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk in CKD patients. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.

scholarly journals The low-protein diet for chronic kidney disease: 8 years of clinical experience in a nephrology ward

2019 ◽  
Vol 13 (2) ◽  
pp. 253-260 ◽  
Author(s):  
Ivano Baragetti ◽  
Ilaria De Simone ◽  
Cecilia Biazzi ◽  
Laura Buzzi ◽  
Francesca Ferrario ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Independent Predictor ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein ◽  
Stage 4 ◽  
Ckd Stage ◽  
Severe Chronic Kidney Disease

Abstract Background Guidelines indicate that a low-protein diet (LPD) delays dialysis in severe chronic kidney disease (CKD). We assessed the value of these guidelines by performing a retrospective analysis in our renal clinical practice. Methods The analysis was performed from 1 January 2010 to 31 March 2018 in 299 CKD Stage 4 patients followed for 70 months in collaboration with a skilled nutritionist. The patients included 43 patients on a controlled protein diet (CPD) of 0.8 g/kg/day [estimated glomerular filtration rate (eGFR) 20–30 mL/min/1.73 m2 body surface (b.s.)], 171 patients on an LPD of 0.6 g/kg/day and 85 patients on an unrestricted protein diet (UPD) who were not followed by our nutritionist (LPD and UPD, eGFR <20 mL/min/1.73 m2 b.s.). Results eGFR was higher in CPD patients than in UPD and LPD patients (21.9 ± 7.4 mL/min/1.73 m2 versus 17.6 ± 8.00 mL/min/1.73 m2 and 17.1 ± 7.5 mL/min/1.73 m2; P = 0.008). The real daily protein intake was higher in UPD patients than in LPD and CDP patients (0.80 ± 0.1 g/kg/day versus 0.6 ± 0.2 and 0.63 ± 0.2 g/kg/day; P = 0.01). Body mass index (BMI) was stable in the LPD and CPD groups but decreased from 28.5 ± 4.52 to 25.4 ± 3.94 kg/m2 in the UPD group (P < 0.001). The renal survival of UPD, LPD and CPD patients was 47.1, 84.3 and 90.7%, respectively, at 30 months (P < 0.001), 42.4, 72.0 and 79.1%, respectively, at 50 months (P < 0.001) and 42.4, 64.1 and 74.4%, respectively, at 70 months (P < 0.001). The LPD patients started dialysis nearly 24 months later than the UPD patients. Diet was an independent predictor of dialysis [−67% of RR reduction (hazard ratio = 0.33; confidence interval 0.22–0.48)] together with a reduction in BMI. Conclusions An LPD recommended by nephrologists in conjunction with skilled dietitians delays dialysis and preserves nutritional status in severe CKD.

scholarly journals The relative effects of a low-protein-high-carbohydrate diet on the free amino acid composition of liver and muscle

1976 ◽  
Vol 36 (2) ◽  
pp. 219-230
Author(s):  
P. G. Lunn ◽  
R. G. Whitehead ◽  
B. A. Baker
Keyword(s):  
Amino Acids ◽  
Amino Acid ◽  
Free Amino Acid ◽  
Acid Concentration ◽  
Free Amino ◽  
Essential Amino Acids ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Total Amino Acid ◽  
Low Protein

1. Free amino acid concentrations in the plasma have been compared with those in liver and quadriceps muscle, in rats fed on diets containing 209 (control) and 31 (low-protein) g protein/kg. The effects of the low-protein diet on diurnal variations in these values were also measured.2. In the plasma, the total amino acid concentration was significantly lower in animals given the low-protein diet, at all times of day except 12.00 hours. In the liver, and to a lesser extent the muscle, total amino acid concentration was maintained.3. In the control animals, diurnal variation in the concentrations of both essential and non-essential amino acids was very similar in plasma, liver and muscle. In animals given the low-protein diet, although the same diurnal pattern was maintained for non-essential amino acids, that occurring among the essential amino acids had virtually disappeared.4. In plasma, the mean 24 h concentration of essential amino acids decreased from 24· mmol/l in control animals to only 1·29 mmol/l in the low-protein-fed animals. Concentrations in muscle and liver were reduced by a similar proportion (from 8·6 to 5·56 μmol/g and from 8·67 to 5·05 μmol/g respectively). Conversely the concentrations of non-essential amino acids in animals given the low-protein diet were increased in plasma (from 1·53 to 2·00 mmol/l), muscle (from 12·5 to 14·3 μmol/g), and liver (from 16·8 to 20·5 μmol/g), muscle showing the lowest increase.5. With the exceptions of lysine, threonine, cystine and tyrosine, the concentrations of all other essential amino acids were reduced more in liver than in muscle. The relationship between this and the failure to maintain plasma albumin concentrations is discussed.

scholarly journals MP449EFFECT OF LOW PROTEIN DIET ON TRIMETHYLAMINE-N-OXIDE PLASMA LEVELS IN NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii593-iii594
Author(s):  
Denise Mafra ◽  
Ana Paula Black Veiga ◽  
Juliana Saraiva dos Anjos ◽  
Peter Stenvinkel ◽  
Peter Bergman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Plasma Levels ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals Tau‐induced brain atrophy and neuroinflammation accelerated by low‐protein diet and decelerated by selected essential amino acids in a murine model of tauopathies

2020 ◽  
Vol 16 (S2) ◽  
Author(s):  
Yuhei Takado ◽  
Hideaki Sato ◽  
Masako Tsukamoto‐Yasui ◽  
Keiichiro Minatohara ◽  
Manami Takahashi ◽  
...  
Keyword(s):  
Amino Acids ◽  
Murine Model ◽  
Brain Atrophy ◽  
Essential Amino Acids ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein
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