Document Detail

Ketodiet, physiological calcium intake and native vitamin D improve renal osteodystrophy.
MedLine Citation:
PMID:  1453606     Owner:  NLM     Status:  MEDLINE    
The effects of a very low-protein diet (VLPD) supplemented with amino acids and ketoanalogues (KA) and with 1 g of calcium carbonate and 1000 IU of vitamin D2, were studied in 17 patients with advanced renal failure (GFR < or = 20 ml/min) over a period of one year. The protein intake was 0.3 g protein/kg body wt/day. Daily phosphorus and calcium intake were respectively 1,500 mg and 300 mg. Sequential bone densitometry was performed and bone histomorphometry after double tetracycline labeling was evaluated, before and after one year of diet. Calcium and phosphate metabolism parameters were monitored every two months. In spite of a significant decrease of GFR, phosphorus, parathyroid hormone (1-84) and osteocalcin plasma levels decreased significantly, while low plasma bicarbonate normalized, and calcitriol and calcium levels remained respectively low and normal. Before the diet, histological study disclosed four cases of mixed osteopathy: osteomalacia associated with osteitis fibrosa (OM/OF), nine pure osteitis fibrosa (OF) and four with normal bone remodeling (NB). After one year of diet, the OM component of OM/OF disappeared, as evidenced by a normalization of the mineral apposition rate and osteoid thickness. In the patients presenting pure OF, a significant decrease in osteoblastic and osteoclastic surfaces, in the number of osteoclasts, and in the bone formation rate (BFR) were found. Vertebral mineral density measured by quantitative computerized tomodensitometry did not change significantly. In conclusion, this study not only confirms the beneficial effects of VLPD + KA + calcium on uremic hyperparathyroid bone disease in advanced renal failure assessed using static bone histomorphometry, but also shows a correction of histodynamic bone parameters.(ABSTRACT TRUNCATED AT 250 WORDS)
M H Lafage; C Combe; A Fournier; M Aparicio
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Kidney international     Volume:  42     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  1992 Nov 
Date Detail:
Created Date:  1993-01-07     Completed Date:  1993-01-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1217-25     Citation Subset:  IM    
Service de Néphrologie, Hôpital Pellegrin, Bordeaux, France.
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MeSH Terms
Amino Acids / administration & dosage
Bone and Bones / pathology
Calcium / metabolism
Calcium, Dietary / administration & dosage*
Combined Modality Therapy
Dietary Proteins / administration & dosage*
Food, Formulated
Ketones / administration & dosage
Middle Aged
Osteomalacia / therapy
Parathyroid Hormone / blood
Phosphates / metabolism
Renal Osteodystrophy / pathology,  physiopathology,  therapy*
Vitamin D / administration & dosage*
Reg. No./Substance:
0/Amino Acids; 0/Calcium, Dietary; 0/Dietary Proteins; 0/Ketones; 0/Parathyroid Hormone; 0/Phosphates; 1406-16-2/Vitamin D; 7440-70-2/Calcium

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