Obesity and progression of chronic renal insufficiency: a Czech long term prospective double-blind randomised multicentre study

Czech version

Authors: V. Teplan ^1,2; O. Schück ^1,2; V. Hanzal ¹; J. Hajný ³; M. Horáčková ⁴; M. Ryba ⁵; I. Staněk ⁶; S. Šurel ⁷; M. Bret ⁸; M. Štollová ¹; D. Sasaková ¹
Authors‘ workplace: Klinika nefrologie, Transplantační centrum IKEM, přednosta prof. MUDr. Vladimír Teplan, DrSc. ¹; Subkatedra nefrologie IPVZ, Praha, vedoucí prof. MUDr. Vladimír Teplan, DrSc. ²; HDS Chrudim, vedoucí lékař MUDr. Jan Hajný ³; Interní klinika 2. lékařské fakulty UK a FN Motol, Praha, přednosta doc. MUDr. Milan Kvapil, CSc. ⁴; Krajská nemocnice Liberec, Department č. l, vedoucí MUDr. Pavel Lang ⁵; Interní oddělení Nemocnice, České Budějovice, přednosta prim. MUDr. Pavel Havránek ⁶; Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc. ⁷; Interní oddělení NsP, Česká Lípa, přednosta prim. MUDr. Romana Balková ⁸
Published in: Vnitř Lék 2006; 52(6): 571-576
Category: Original Contributions

Práce byla přednesena na Českém nefrologickém kongresu v Luhačovicích ve dnech 17. - 19. 6. 2004 a na 12. mezinárodním kongresu Nutrice a metabolizmus u chorob ledvin konaném v Padově ve dnech 18. - 22. 6. 2004. V doplněné a rozšířené podobě pak na 27. Evropském kongresu pro parenterální a enterální výživu v Bruselu ve dnech 26. - 31. 8. 2005.

Overview

Obesity represents one of serious risk factors in chronic renal failure patients (CRF). In three years prospective double-blind randomised multicentre study we monitored 66 patients with advanced chronic renal insufficiency, GFR 24.4-37.3 ml/min (0.41-0.62 ml/s) and BMI ≥ 30 kg/m² on long term low-protein diet (0.6 P/kg BW/day) and ACEi + ARB. Thirty four randomly selected patients (group I) were treated with keto amino acids, 32 patients in control group (group II) with placebo. During the study period significant decrease of BMI, proteinuria and slowing in progression of renal failure (C_in) were found. Significant changes were also noted in parameters of albumin and transferrin (p < 0.02), leucin and WQ (p < 0.01 - p < 0.02), glycaemia and HbA_1c (p < 0.02), triglycerides (p < 0.01), leptin and ObRe (p < 0.01) and selected parameters of endothelial dysfunction (ET₁, p < 0.02, TGFβ₁, p < 0.02). Significantly also decreased PTH value (p < 0.01). Successful treatment of obesity can significantly improve long term prognosis in CRF patients.

Key words:
obesity - renal insufficiency - keto amino acids - progression

Sources

1. Lachmanová J. Statistická ročenka dialyzační léčby v České republice. Praha: Česká nefrologická společnost 2004.

2. Praga M. Obesity - a neglected culprit in renal disease. Nephrol Dial Transpl 2002; 17: 1157-1159.

3. Kambham N, Markowitz GS, Valeri AM et al. Obesity - related glomerulopathy: An emerging epidemic. Kidney Int 2001; 59: 1498-1509.

4. Klassen A, Sebekova K, Heidland A et al. Obesity - a neglected risk factor of the Kidney. Nieren und Hochdruckkrankheiten 2003; 32: 189-196.

5. Wellen KE, Hotamisligil GS. Obesity-induced inflammatory changes in adipose tissue. J Clin Invest 2003; 112: 1785-1788.

6. Agnami S, Vachharajani VT, Gupta R et al. Does treating obesity stabilize chronic kidney disease? BMC Nephrology 2005; 6: 1-4.

7. Pelikánová T. Metabolický syndrom. Vnitř Lék 2003; 49: 900-906.

8. Wiecek A, Kokot F, Chudek J et al. The adipose tissue - a novel endocrine organ of interest to the nephrologist. Nephrol Dial Transpl 2002; 17: 191-195.

9. Axelsson J, Heimbűrger O, Lindholm B et al. Adipose lissue and its relation to inflammation the role of adipokines. J Renal Nutr 2005; 15: 131-136.

10. Stenvinkel P, Marchlewska A, Pecoits-Filho R et al. Adiponectin in renal disease: Relationship to phenotype and genetic variation in the gene encoding adiponectin. Kidney Int 2004; 65: 274-281.

11. Andrlová K, Haluzík M. Tuková tkáň a insulinová rezistence. Diab Met Endrokrin Výživa 2005; 8: 87-96.

12. Zoccali C, Mallamaci F, Panuccio V et al. Adiponectin is markedly increased in patients with nephrotic syndrome and is related to metabolic risk factors. Kidney Int 2003; 63(Suppl 84): 98-102.

13. Zoccali C, Mallamaci F, Tripetpi G. Adipose tissue as a source of inflammatory cytokines in health and disease: focus and-stage renal disease. Kidney Int 2003; 63(Suppl 84): 65-68.

14. Xu H, Barnes GT, Yang Q et al. Chronic inflammation in fat plays a crucial role: In the development of obesity-related insulin resistance. J Clin Invest 2003; 112: 1821-1830.

15. Olšovský J. Obezita a diabetes. Vnitř Lék 2003; 49: 956-957.

16. Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest 2005; 115: 1111-1119.

17. Mitch W. Are supplements of ketoacids and amino acids useful in treating patients with chronic renal failure? Wien Klin Wocheschr 2000; 112: 863-864.

18. Teplan V, Schűck O, Horačková M at al. Effect of keto acid-amino acid supplement on the metabolism and renal elimination of branched-chain amino acids in patients with chronic renal insufficiency on a low protein diet. Wien Klin Wochenschr 2000; 112: 876-881.

19. Teplan V, Schűck O, Votruba M at al. Metabolic effect of keto acid-amino acid supplementation in patients with chronic renal insufficiency receiving a low-protein diet and recombinant human erythropoetin - A randomized controlled trial. Wien Klin Wochenschr 2001; 113: 661-669.

20. Teplan V, Schück O, Knotek A et al. Enhanced metabolic effect of erythropoetin and keto acids in CRF patients on low-protein diet: Czech multicenter study. Am J Kidney Dis 2003; 41: Suppl 1: 26-30.

21. Di Iorio BR, Minutolo R, de Nicola LD et al. Supplemented very low protein diet ameliorates responsiveness to erythropoetin in chronic renal failure. Kidney Int 2003; 64: 1822-1828.

22. Meloni C, Taangelo P, Cipriani S et al. Adequate protein dietary restriction in diabetic and nondiabetic patients with chronic renal failure. J Ren Nutr 2004; 14: 208-213.

23. Prakash S, Prasad Pande D, Sharma S et al. Randomized, double-blind, placebo-controlled trial to evaluate efficacy of keto diet in predialytic chronic renal failure. J Ren Nutr 2004; 14: 89-96.

24. Teplan V. Pharmacological features of keto amino acid therapy. Am J Nephrol 2005; 25(Suppl 1): 13-14.

25. Chauveau P, Vendrely B, Haggan W et al. Body composition of patients on a very low-protein diet: a two-year survey with DEXA. J. Ren Nutr 2003; 4: 282-287.

26. Schück O, Teplan V, Štollová M et al. Estimation of glomerular filtration rate in obese patients with chronic renal impairment based on serum cystatin C levels. Clin Nephrol 2004; 62: 92-96.

27. Clinical Practice guidelines for chronic kidney disease (K/DOQI) National Kidney Foundation. New York 2002.

28. Schück O, Smrčková J, Teplan V et al. Nová metoda stanovení glomerulární filtrace na podkladě sérové koncentrace kreatininu, močoviny a albumimu (MDRD). Vnitř Lék 2004; 50: 507-509.