Hypertension and nephrology

[Role of ketoanalogue amino acids and diet in the treatment of patients with chronic kidney disease]

KISS István, HARIS Ágnes, DEÁK György

SEPTEMBER 14, 2018

Hypertension and nephrology - 2018;22(03 klsz)

[Low protein diet is an important component of the non-pharmacological treatment of patients with chronic kidney disease (CKD). Along with the diet it is important to maintain appropriate energy intake to avoid malnutrition. It is recommended to supplement low protein diet (0.6-0.7 g protein/kg body weight/day) with essential amino acids and their ketoanalogues (ketoacids) in a dose of 1 tablet/8-10 kg body weight if there is a threat of protein malnutrition (eg. vegan diet). Very low protein diet (0.3-0.4 g protein/kg body weight/day) should be supplemented with ketoacids in a dose of 1 tablet/5 kg body weight. Low protein diet is recommended for patients with CKD stage 3 and progressively declining renal function, or nephrotic syndrome; in diabetic nephropathy; in CKD stage 4 and non-dialyzed CKD stage 5. Nephroprotective effect of very low protein diet is primarily expected is patients with an eGFR below 20-25 ml/min/1.73 m2 and good compliance. Dietary protein restriction may diminish acidosis and proteinuria, slow the progression of CKD and delay initiation of dialysis. Diets reduced in protein supplemented with appropriate energy intake and ketoacids are nutritionally safe. Dietary education and guidance of patients by qualified dietitians are of great importance in nephrology clinics. We illustrate the main points of our review with case reports.]

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[The year 2017 saw the continuation of Hungary’s greatest and to date most comprehensive health screening program started in 2010. The examinations - among them coronary examinations - covered the fields of cardiology and hypertension, they took place in a specially furnished lorry. In the program we measured blood pressure, pulse rate, calculated cardiovascular risk, plasma cholesterol, glucose and uric acid levels. Whole body analysis started with measuring height, weight, abdominal circumference and waist/hip ratio defining target body weight. Following the measurement of body fat and muscle content we decided the surface volume of the abdominal fat and calculated body mass index. Participants and results of the examinations of the people who have presented themselves for the test since 2017 have been evaluated. In the Program a total (52.2%) women and (47.8%) men were tested at 204 locations. Upon data processing with the help of a query 21.9% of the participants reported suffering from hypertension. The screening truck has been to 1505 places is Hungary, and travelled 183,335 km, 135,879 people have participated in comprehensive screening. The average systolic blood pressure among women was in the normal range up to the age of 55 years. The diastolic blood pressure levels were in the normal range for both sexes (with the exception of the age group 46-55 of men where it exceeded the upper limit of the normal range by a minimal extent). Among men stage 1 hypertension was the most frequent status for all age groups; blood pressures above 140/90 were measured for 39% of subjects from age 18 onwards. Conclusions: Thanks to the vast information obtained through the program a comprehensive picture has been drawn about Hungary’s present health status not only on a regional or cross sectional level but as it was described in the program, too.]

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