Very low protein diets supplemented with keto-analogues in ESRD predialysis patients and its effect on vascular stiffness and AVF Maturation

• Published in: BMC nephrology 2016-09, Vol.17 (1), p.131, Article 131
• Main Authors: David, Cristiana, Peride, Ileana, Niculae, Andrei, Constantin, Alexandra Maria, Checherita, Ionel Alexandru
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amino Acids, Essential - administration & dosage; Arteriovenous Shunt, Surgical - methods; C-Reactive Protein - metabolism; Care and treatment; Chronic kidney failure; Cohort Studies; Diet, Protein-Restricted - methods; Female; Fistula, Arteriovenous; Health aspects; Humans; Keto Acids - administration & dosage; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - diet therapy; Low-protein diet; Male; Middle Aged; Nephrology; Prospective Studies; Renal Dialysis; Risk factors; Treatment Outcome; Vascular Stiffness - drug effects; Vascular Stiffness - physiology
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-016-0347-y

Native arteriovenous fistula (AVF) is the most appropriate type of vascular access for chronic dialysis. Its patency rates depend on vascular wall characteristics. Ketoacid analogues of essential amino acids (KA/EAA) are prescribed in end-stage renal disease (ESRD) pre-dialysis patients to lower toxic metabolic products generation and improve nutritional status. We hypothesized that very-low protein diet (VLPD) supplemented with KA/EAA may influence arterial wall stiffness and affect AVF maturation rates and duration in pre-dialysis ESRD patients. In a prospective, cohort, 3 years study we enrolled 67 consecutive non-diabetic early referral ESRD patients that underwent AVF creation in our hospital. Patients were divided in two groups based on their regimen 12 months prior to surgery: a VLPD supplemented with KA/EAA study group versus a low protein diet non-KA/EAA-supplemented control group. For each patient we performed serum analysis for the parameters of bone mineral disease, inflammation and nutritional status, one pulse wave velocity (PWV) measurement and one Doppler ultrasound (US) determination prior the surgery, followed by consequent Doppler US assessments at 4, 6, 8 and 12 weeks after it. Rates and duration of mature AVF achievement were noted. We used logistic regression to analyze the association between AVF maturation and KA/EAA administration, by comparing rates and durations between groups, unadjusted and adjusted for systolic blood pressure, C-reactive protein, PWV, phosphorus values. All parameters in the logistic model were transformed in binary variables. A p-value