Ketoanalogue of essential amino acids in patients with inflammatory bowel disease (IBD) and chronic kidney disease (CKD) in preparation for kidney transplantation

Česká verze

Authors: Teplan V. ^{1 2 3}
Authors place of work: Klinické a výzkumné centrum pro střevní záněty, Klinické centrum ISCARE a. s. a 1. LF UK v Praze ¹; Subkatedra nefrologie, IPVZ, Praha, Klinika nefrologie, Institut klinické a experimentální mediciny, Praha ²; Interní a kardiologická klinika FN a Katedra interních oborů, LF OU, Ostrava ³
Published in the journal: Gastroent Hepatol 2022; 76(2): 131-140
Category: Vybrané kapitoly z vnitřního lékařství
doi: https://doi.org/10.48095/ccgh2022131

Summary

Over the last decades, a remarkable increase has been confirmed in the number of inflammatory bowel disease (IBD) patients with chronic kidney disease (CKD), requiring a combined management of bowel and kidney diseases. In stabilized IBD patients on biologic therapy, it is necessary to consider further steps in the management of chronic renal insufficiency, followed by renal replacement therapy (dialysis, kidney transplant). To prepare for it in time, is it necessary to start the patient on a modified diet with reduced protein intake and on keto amino acids in an effort to prepare for preemptive kidney transplantation (the most effective method in the management of kidney failure prior to initiating regular dialysis in patients with measured glomerular filtration rate under 0.16 ml/s) from a living or cadaveric donor. At the same time, we have to continue with biologic therapy. In patients with extensive ileocaecal resection or ileostomia, it is necessary to carefully monitor the parameters of water and electrolyte balance in order to prevent metabolic disorders and progression of renal insufficiency. Our previous studies involving over 3,000 patients with kidney disease have demonstrated the effect of the well-tolerated protein restricted diet supplemented with keto amino acids in long time management. With a coexisting GIT involvement, an individualized approach is required depending on disease dynamics in order to avoid the risk of hidden malnutrition.

Keywords:

inflammatory bowel disease – kidney transplantation – chronic kidney disease – keto amino acids

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