F. Ciardella

Effects on Renal Function of a Low-Nitrogen Diet Supplemented with Essential Amino Acids and Ketoanalogues and of Hemodialysis and Free Protein Supply in Patients with Chronic Renal Failure

Creatinine clearance has been repeatedly measured in three groups of chronic uremics. In the first control group (31 cases), following a conventional low-protein diet, creatinine clearance declined linearly with time. In the second group (12 cases), following very low nitrogen diet supplemented with essential amino acids and ketoanalogues, creatinine clearance remained practically constant with only one exception in which it continued to decline. In the third group of uremics (13 cases) on repeated dialysis therapy, the deterioration of creatinine clearance was markedly accelerated. The possible explanations and the practical implications of these findings are discussed.

Reversal of Hyperparathyroidism in Severe Uremics Following Very Low-Protein and Low-Phosphorus Diet

Serum iPTH levels decreased markedly in 16 severe chronic uremic patients who changed from a standard low-protein diet to a very low-nitrogen and very low-phosphorus diet supplemented with essential a

Effects of a Low Phosphorus, Low Nitrogen Diet Supplemented with Essential Amino Acids and Ketoanalogues on Serum Triglycerides of Chronic Uremic Patients

The effects were studied of a vegetarian low-protein, low-phosphorus diet supplemented with essential amino acids and ketoanalogues and those of maintenance hemodialysis (MHD) and free diet on the serum triglycerides (STG) of 85 patients with chronic renal failure. Following dietary therapy STG decreased significantly in the 61 male patients (from 185.7 +/- 89.8 to 153.5 +/- 68.7 mg/dl; p less than 0.001), whereas in the females the decrease was not significant (from 189.1 +/- 83.9 to 167.0 +/- 62.2 mg/dl; NS). When patients changed to MHD therapy and free diet STG increased again. We can conclude that the correction of hypogonadism of chronic male uremics largely accounts for the improvement of hypertriglyceridemia, though other factors are likely to contribute.

Combined Therapy for Selected Chronic Uremic Patients: Infrequent Hemodialysis and Nutritional Management

The results are described of a combined nutritional (supplemented diet) and dialytic (once a week hemodialysis) therapy, employed in 17 selected chronic uremics for a mean period of 18.2 months/patient. The clinical findings, blood chemical abnormalities and changes of renal function were examined and compared with those of patients on the standard thrice-a-week dialysis schedule and free diet. The clinical findings were not significantly different in the two groups. The residual renal function of patients on combined therapy declined faster than in patients on conservative treatment, but at a slower rate than in those on thrice-a-week dialysis. The time averages of serum urea, methylguanidine and phosphate concentrations and their postdialytic rebounds were lower in the patients on combined therapy than in those on thrice-a-week dialysis, whereas the time averages of the serum creatinine concentration were higher, and those of serum bicarbonate and serum oxalate were not significantly different in the two groups. It is concluded that this combined therapy is a valid alternative to the conventional thrice-a-week hemodialysis and free diet for selected patients and for periods of time whose duration is conditioned by the rate of decline of the residual renal function.

Effects of a low-phosphorus, low-nitrogen diet supplemented with essential amino acids and ketoanalogues on serum beta-endorphin in chronic renal failure

The effects of a vegetarian low-protein, low-phosphorus diet supplemented with essential amino acids and ketoanalogues, on the serum beta-endorphin, growth hormone, parathyroid hormone, thyroid hormones (T3 and T4), pituitary TSH and total cortisol were studied in 12 male chronic uremics. beta-Endorphin decreased, as well as growth hormone. Parathyroid hormone and T3 improved significantly, reaching almost normal values. It is hypothesized that the correction of the beta-endorphin excess may account in part for the improvement of some endocrinological and metabolic effects exerted by this dietary treatment. The possible pathophysiological mechanisms which could explain the antiendorphinic action of this treatment in uremic patients are discussed, as well as the possible beneficial endocrine and metabolic effects exerted by the fall in circulating beta-endorphin.

Protection of Renal Function and of Nutritional Status in Uremic Rats by Means of a Low-Protein, Low-Phosphorus Supplemented Diet

A low-protein, low-phosphorus diet supplemented with essential amino acids and keto analogues was given to 12 rats, starting from the 90th day after subtotal nephrectomy. The purpose was to assess its effect on the residual renal function and on the nutritional status in rats with already established severe renal failure. Ten control rats in the same conditions, following a standard diet supplying normal amounts of protein and phosphorus were also studied. The supplemented diet exerted a well-evident protection of residual renal function and structure: lower rate of decline of creatinine clearance, lower mortality, significant decrease of proteinuria and almost total absence of histological signs of activity. The nutritional status was also well protected by the dietary therapy: increase of body weight, normal values of total serum protein, and low-constant values of urea appearance. In the control rats body weight decreased, total serum protein was lower than normal and the values of urea appearance were increasing simultaneously with a decreasing food intake and body weight.

Effects of Erythropoietin Administration on Prolactin Secretion in Normal Subjects

To evaluate the acute effect of human erythropoietin (r-HuEPO) on basal and stimulated prolactin (PRL) secretion, 18 normal subjects (12 females, 6 males) were studied. The PRL response to thyrotropin-releasing hormone (TRH; 200 micrograms intravenously, n = 7), metoclopramide (MCP, 20 mg intravenously, n = 5) and fenfluramine (FF, 60 mg os, n = 6) was tested in presence of saline or r-HuEPO (30 U/kg intravenously). The drug neither modified basal PRL levels nor affected the normal PRL release to TRH, MCP and FF. Our results indicate that, in normal subjects, the acute administration of therapeutic doses of r-HuEPO does not interfere with PRL secretion both after a direct pituitary stimulus and after stimuli involving dopaminergic and serotoninergic pathways.

Effect of amino acid, ketoacid supplementation to a low-protein diet on diabetic nephropathy with chronic renal failure

Type 1 diabetics with ‘overt’ diabetic nephropathy (DN) have a rapid decline of GFR, reaching the uremic status within a few months or years. In the present study we have submitted to a vegetarian a low-protein diet, supplemented with amino acids and their analogues (Supplemented diet, SD) fourteen patients with DN and chronic renal failure (CRF). All the patients were followed up during a 15.8 month (9–25) period of unrestricted protein diet (UPD), and successively during 22.3 months (6–42) of SD. The monthly decrease of creatinine clearance on UPD was -1.42 ± 0.38 ml/min, while on SD it dropped to -0.29 ± 0.24 ml/min (p<0.001). Urinary protein loss decreased (6.02 ± 1.74 to 3.28 ± 1.12 g/day; p<0.01), independently from any change either in creatinine clearance or in serum albumin concentration. The daily insulin requirement was reduced despite the very high carbohydrate intake. PTH and GH fell, while T3 increased significantly. Serum Cortisol decreased from 187.9 ± 42.5 to 139.8 ± 25.6 ng/ml (p<0.005).

A low-protein diet supplemented with amino acids and their analogues lowers circulating ß-endorphins in chronic uremic patients

In twelve male chronic uremics we studied the effect of a pure vegetarian, low-protein diet supplemented with amino acids and analogues on serum s-endorphin, parathyroid hormone, growth hormone, thyroid hormones, TSH and total Cortisol.