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Titolo	Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial
Autore	Na Jiang1, Jiaqi Qian1, Weilan Sun1, Aiwu Lin1, Liou Cao1, QinWang1, Zhaohui Ni1, Yanping Wan2, Bengt Linholm3, Jonas Axelsson3 and Qiang Yao1 - 1Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, 2Nutritional Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People?s Republic of China and 3Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
Referenza	Nephrol Dial Transplant (2009); doi: 10.1093/ndt/gfp085
Contenuto	Background. While a low-protein diet may preserve residual renal function (RRF) in chronic kidney disease (CKD) patients before the start of dialysis, a high-protein intake is usually recommended in dialysis patients to prevent protein-energy wasting. Keto acids, which were often recommended to pre-dialysis CKD patients treated with a lowprotein diet, had also been reported to be associated with both RRF and nutrition maintenance. We conducted a randomised trial to test whether a low-protein diet with or without keto acids would be safe and associated with a preserved RRF during peritoneal dialysis (PD). Methods. To assess the safety of low protein, we first conducted a nitrogen balance study in 34 incident PD patients randomized to receive in-centre diets containing 1.2, 0.9 or 0.6 g of protein/kg ideal body weight (IBW)/day for 10 days. Second, 60 stablePDpatients [RRF4.04±2.30 ml/ min/1.73 m2, urine output 1226 ± 449 ml/day, aged 53.6 ± 12.8 years, PD duration 8.8 (1.5-17.8) months] were randomized to receive either a low- (LP: 0.6-0.8 g/kg IBW/day), keto acid-supplemented low- (sLP: 0.6-0.8 g/kg IBW/day with 0.12 g/kg IBW/day of keto acids) or highprotein (HP: 1.0-1.2 g/kg IBW/day) diet. The groups were followed for 1 year and RRF as well as nutritional status was evaluated serially. Results. A neutral or positive nitrogen balance was achieved in all three groups. RRF remained stable in group sLP (3.84 ± 2.17 to 3.39 ± 3.23 ml/min/1.73 m2, P = ns) while it decreased in group LP (4.02 ± 2.49 to 2.29 ± 1.72 ml/min/1.73 m2, P < 0.05) and HP (4.25 ± 2.34 to 2.55 ± 2.29 ml/min/1.73 m2, P< 0.05). There was no change from baseline on nutritional status in any of the groups during follow-up. Conclusions. A diet containing 0.6-0.8 g of protein/kg IBW/day is safe and, when combined with keto acids, is associated with an improved preservation of RRF in relatively new PD patients without significant malnutrition or inflammation.
Data	20.03.2009

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