Document Detail


Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease.
MedLine Citation:
PMID:  17035939     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Blood pressure (BP) is hardly controlled in chronic kidney disease (CKD). We compared the effect of very low protein diet (VLPD) supplemented with ketoanalogs of essential amino acids (0.35 g/kg/day), low protein diet (LPD, 0.60 g/kg/day), and free diet (FD) on BP in patients with CKD stages 4 and 5. Vegetable proteins were higher in VLPD (66%) than in LPD (48%). LPD was prescribed to 110 consecutive patients; after run-in, they were invited to start VLPD. Thirty subjects accepted; 57 decided to continue LPD; 23 refused either diet (FD group). At baseline, protein intake (g/kg/day) was 0.79+/-0.09 in VLPD, 0.78+/-0.11 in LPD, and 1.11+/-0.18 in FD (P<0.0001). After 6 months, protein intake was lower in VLPD than LPD and FD (0.54+/-0.11, 0.78+/-0.10, and 1.04+/-0.21 g/kg/day, respectively; P<0.0001). BP diminished only in VLPD, from 143+/-19/84+/-10 to 128+/-16/78+/-7 mm Hg (P<0.0001), despite reduction of antihypertensive drugs (from 2.6+/-1.1 to 1.8+/-1.2; P<0.001). Urinary urea excretion directly correlated with urinary sodium excretion, which diminished in VLPD (from 181+/-32 to 131+/-36 mEq/day; P<0.001). At multiple regression analysis (R2=0.270, P<0.0001), BP results independently related to urinary sodium excretion (P=0.023) and VLPD prescription (P=0.003), but not to the level of protein intake. Thus, in moderate to advanced CKD, VLPD has an antihypertensive effect likely due to reduction of salt intake, type of proteins, and ketoanalogs supplementation, independent of actual protein intake.
Authors:
V Bellizzi; B R Di Iorio; L De Nicola; R Minutolo; P Zamboli; P Trucillo; F Catapano; C Cristofano; L Scalfi; G Conte;
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article     Date:  2006-10-11
Journal Detail:
Title:  Kidney international     Volume:  71     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-25     Completed Date:  2007-03-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  245-51     Citation Subset:  IM    
Affiliation:
Nephrology Unit, A Landolfi Hospital, Solofra, Italy. vincenzo.bellizzi@tin.it
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00323713
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MeSH Terms
Descriptor/Qualifier:
Aged
Amino Acids, Essential / administration & dosage*,  chemistry
Blood Pressure / drug effects
Chronic Disease
Diet, Protein-Restricted*
Female
Humans
Hypertension, Renal / diet therapy*
Ketones / administration & dosage*,  chemistry
Kidney Diseases / complications*
Male
Middle Aged
Prospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Amino Acids, Essential; 0/Ketones
Comments/Corrections
Comment In:
Kidney Int. 2007 Feb;71(3):188-90   [PMID:  17252027 ]

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