International Journal of Biomedicine (Sep 2013)
Influence of Diet Balanced with Essential Amino Acids / Keto Acid Analogs and High-Nutrient Blend on the Progression of Renal Failure in Patients in the Pre-Dialysis Stage of Chronic Kidney Disease Caused by Systemic Autoimmune Diseases
Abstract
The aim of the study was to evaluate the effect of a low protein diet (LPD) balanced with essential amino acids (EAA) / keto acid analogs (KAA) and protein “SUPRO-XT 219D” in the composition of the high-energy nutrient blend (HENB) for slow down of renal failure in patients in the pre-dialysis stage of chronic kidney disease (CKD) induced by systemic autoimmune diseases (SAD).Material and Methods: In this study, 46 patients (35 with systemic lupus erythematosus and 15 with various forms of systemic vasculitis) with CKD in stages 3-4 were randomized into three groups. Group 1 (18 patients: 10 with CKD stage 3 and 8 with CKD stage 4) was given LPD (0.6 g protein per kg of body weight per day comprising 0.3 g of vegetable protein and 0.3 g of animal protein) balanced with EAA/KAA (Diet #1); Group 2 (18 patients: 9 with CKD stage 3 and 9 with CKD stage 4) was given the same LPD, but with an increased vegetable protein content (purified soy protein SUPRO-XT 219D) up to 0.4 g/kg/day in the composition of HENB (Diet #2); Group 3, comparison group, (10 patients: 7 with CKD stage 3 and 3 with CKD stage 4) was given a free diet (Diet #3) based on the patient’s personal preferences. Both options of LPD were offered to all the patients of Groups 1 and 2 regardless of their baseline nutritional status (NS). The duration of the observation was 24-48 months. The NS was evaluated based on the bioelectrical impedance analysis. The protein and calorie intake was calculated from the 3-day food diary.Results: Among the 46 patients with CKD stages 3-4, NS impairment was detected in almost half the patients (45.7%). Both forms of LPD were well tolerated. The correction of the nutritive impairment was achieved in patients with baseline impaired NS; the remaining patients of Groups 1 and 2 demonstrated the safety of NS against LPD. At the same time, among Group 3 patients, during the progression of renal disorders, the NS rate was observed to increase by 1.5 times (from 40% to 60%). Slowing down the glomerular filtration rate (GFR) decline was observed in the patients treated with LPD for at least a year, which was more significant in the subgroup fed with the increased quota of vegetable protein SUPRO-XT 219D.Conclusion: Early restriction (on pre-dialysis stage) of the protein intake (0.6 g/kg/day) supplemented with HENB and EAA/KAA revealed a positive effect on the NS of CKD patients and was found to be able to slow down the GFR decline.
