Peter T. Fröhling

Suppression of Parathyroid Hormone by Therapy with a Mixture of Keto Analogues/Amino Acids in Hemodialysis Patients

In the present study the influence of a mixture of keto analogues/amino acids (KA) on PTH levels in 18 RDT patients was examined. Ten of them were treated with KA over a period of 3 months, while the other 8 patients served as control group. The KA-treated patients showed a significant fall in PTH and plasma phosphate levels, while no changes of plasma 25-OH-D or plasma calcitonin were observed. Consequently, KA administration may also be beneficial with respect to control of secondary hyperparathyroidism.

Therapeutic effect of keto acids on renal osteodystrophy. A prospective controlled study.

The therapeutical effect of keto acids on bone histology was investigated in a prospective randomized controlled study of 40 patients. A marked improvement in osteofibrotic as well as in osteomalacic changes was found in bone biopsies after 12 months of treatment with keto acids.

Serum 25-Hydroxyvitamin D in Patients with Chronic Renal Failure on Long-Term Treatment with High Doses of Vitamin D2

The present study was aimed at answering the following two questions: (1) What is the effect of high dose vitamin D treatment on the serum level of 25-hydroxyvitamin D (25-OH-D) in patients with chronic renal failure (CRF)? (2) Is there any effect of urinary protein loss on the serum 25-OH-D levels during treatment with pharmacological doses of vitamin D? 42 patients with CRF were studied. They were treated conservatively by a low protein diet and received 15 mg of vitamin D2 once a week. Long-term administration of vitamin D caused a significant (5- to 7-fold) increase of plasma 25-OH-D level irrespective of the degree of proteinuria. This increase was noted only during the first 5 months of vitamin D2 treatment. Surprisingly only in some patients moderate hypercalcemia (> 2.75 mmol/l) was found. From the results obtained it is concluded that (1) patients with CRF differ from normal subjects in handling of high doses of vitamin D and (2) high dosage treatment with vitamin D may prevent hypocalcemia in patients with CRF in spite of high proteinuria.

Successful Pregnancy of a Woman with Advanced Renal Failure on Nutritional Treatment

A case is reported of a successful pregnancy of a woman with advanced renal failure treated nutritionally. The importance of an intensive interdisciplinary medical co-working is stressed, and the individual adaptation of the dietary treatment to the special nutritional requirements in pregnancy is discussed.

Role of Keto Acids in the Prophylaxis and Treatment of Renal Osteopathy

KA administration given in addition to a low-protein diet leads to a reduction of PTH secretion followed by diminishing of osteofibrosis. Osteomalacia will also be reduced by a better control of the calcium-phosphate metabolism, an increase of 1,25-(OH)2-D levels, and a lower burden of aluminum. Therapeutic levels of 25-OH-D and calcitonin (caused by simultaneous administration of vitamin D) are probably necessary to achieve this effect. KA are not only the optimum form of substitution in the nutritional treatment of chronic renal failure, but they seem to be very effective in the treatment of renal osteodystrophy.