TY - JOUR
T1 - The Effect of a Keto Acid-Amino Acid Supplement to a Restricted Diet on the Progression of Chronic Renal Failure
AU - Mitch, William E.
AU - Walser, Mackenzie
AU - Steinman, Theodore I.
AU - Hill, Sylvia
AU - Zeger, Scott
AU - Tungsanga, Kriang
PY - 1984/9/6
Y1 - 1984/9/6
N2 - We treated 24 patients who had chronic renal failure with a low-phosphorus diet containing 20 to 30 g of mixed-quality protein, supplemented by amino acids and their keto analogues. Seventeen patients had well-defined rates of progression before treatment, as assessed by serial determinations of serum creatinine levels. By extrapolating these rates of progression, we found that 10 of the 17 (59 per cent) had a clinically important slower rise in creatinine levels during long-term treatment (average, 20 months) than predicted; none had a faster rise than predicted. Seven of the 17 patients began treatment before creatinine reached the level of 8 mg per deciliter; in six of the seven, followed for an average of 22 months, creatinine has remained at or below the level at the start of treatment. Nutrition, as assessed by body weight, nitrogen balance, serum albumin, and serum transferrin, has been well maintained. This regimen slowed or arrested the rise in creatinine levels and thus must have slowed or halted the progression of renal insufficiency in a majority of cases, especially when treatment was initiated before creatinine had reached the level of 8 mg per deciliter. The mechanism under-lying this effect remains to be determined. (N Engl J Med 1984; 311:623–9.).
AB - We treated 24 patients who had chronic renal failure with a low-phosphorus diet containing 20 to 30 g of mixed-quality protein, supplemented by amino acids and their keto analogues. Seventeen patients had well-defined rates of progression before treatment, as assessed by serial determinations of serum creatinine levels. By extrapolating these rates of progression, we found that 10 of the 17 (59 per cent) had a clinically important slower rise in creatinine levels during long-term treatment (average, 20 months) than predicted; none had a faster rise than predicted. Seven of the 17 patients began treatment before creatinine reached the level of 8 mg per deciliter; in six of the seven, followed for an average of 22 months, creatinine has remained at or below the level at the start of treatment. Nutrition, as assessed by body weight, nitrogen balance, serum albumin, and serum transferrin, has been well maintained. This regimen slowed or arrested the rise in creatinine levels and thus must have slowed or halted the progression of renal insufficiency in a majority of cases, especially when treatment was initiated before creatinine had reached the level of 8 mg per deciliter. The mechanism under-lying this effect remains to be determined. (N Engl J Med 1984; 311:623–9.).
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U2 - 10.1056/NEJM198409063111002
DO - 10.1056/NEJM198409063111002
M3 - Article
C2 - 6472341
AN - SCOPUS:0021136214
SN - 0028-4793
VL - 311
SP - 623
EP - 629
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 10
ER -