Low protein diet with essential amino acids ketoanalogues combination can affect serum FGF-23 and Klotho levels in chronic kidney disease 3b-4 stages patients: randomized pilot study


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Abstract

Protein restriction diet (PRD) with ketoanalagues of essential amino acids (KA) combination can improve of chronic kidney disease (CKD) course while, the precise mechanisms of PRD + KAA action in CKD are not known yet. We have conducted a prospective, randomized, controlled study of PRD and KAA patient’s group in compare with PRD without KAA group in regarding to serum Klotho and FGF-23 levels in patients with CKD. Materials and methods. The study included 79 CKD 3b-4 stages patients, non - diabetic etiology, used PRD (0.6 g/kg/day). The patients were randomized in two groups: 42 patients, received PRD + KAA (Group 1) and 37 patients continued the PRD without KAA (Group 2). Serum FGF-23 (Human FGF-23 ELISA kit with antibodies to native FGF-23 molecule, Merk Millipore MILLENZFGF-23-32K), Klotho (Human soluble Klotho with antiKlotho monoclonal antibodies, IBL-Takara 27998-96Well) levels, as well as instrumental examination: bioimpedance analysis [assess of muscle body mass (MBM), fat body mass (FBM), body mass index (BMI) and others]; sphygmography [assess of augmentation (stiffness) indices (AI), central (aortal) blood pressure (CBP) by «Sphygmacor» device]; as well as echocardiography [assess of cardiac (valvular) calcification score (CCS) and left ventricular myocardium mass index (LVMMI)], were studded in addition to conventional examination. Results and discussion. To the end of 14th month of the study the PRD group reached a body mass index (BMI) decrease (p=0.046), including MBM in men (p=0.027) and woman (p=0.044). In addition, higher FGF-23 (p=0.029), and lower Klotho (p=0.037) serum levels were revealed in the PRD group compared to the PRD+KAA group as well as the increase in AI (p=0.034), CCS (p=0.048), and LVMMI (p=0.023). Conclusion. Use of PRD + KAA provides adequate nutrition status and more efficient correction of FGF-23 and Klotho imbalance in CKD progression that may contribute to alleviation of both cardiovascular calcification and cardiac remodeling in CKD. Importantly, a prolonged PRD use without supplementation of KAA may lead to malnutrition signs.

About the authors

L. Yu Milovanova

Sechenov First Moscow State Medical University (Sechenov University)

Email: Ludm.milovanova@gmail.com
д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии; тел.: +7(916)164-14-00; ORCID: 0000-0002-5599-0350 Sechenov First Moscow State Medical University (Sechenov University)

L. V Kozlovskaya(Lysenko)

Sechenov First Moscow State Medical University (Sechenov University)

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии; ORCID: 0000-0002-1166-7308 Sechenov First Moscow State Medical University (Sechenov University)

T. V Androsova

Sechenov First Moscow State Medical University (Sechenov University)

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии; ORCID: 0000-0002-9951-126X Sechenov First Moscow State Medical University (Sechenov University)

M. V Lebedeva

Sechenov First Moscow State Medical University (Sechenov University)

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии; ORCID: 0000-0002-5923-1837 Sechenov First Moscow State Medical University (Sechenov University)

M. V Taranova

Sechenov First Moscow State Medical University (Sechenov University)

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии; ORCID: 0000-0002-7363-6195 Sechenov First Moscow State Medical University (Sechenov University)

S. Yu Milovanova

Sechenov First Moscow State Medical University (Sechenov University)

д.м.н., в.н.с. НИО здоровьесберегающих технологий Научно-технологического парка биомедицины; ORCID: 0000-0002-2687-6161 Sechenov First Moscow State Medical University (Sechenov University)

T. B Kondratyeva

Sechenov First Moscow State Medical University (Sechenov University)

к.м.н., доц. каф. госпитальной терапии №1 лечебного факультета; ORCID: 0000-0001-7938-1763 Sechenov First Moscow State Medical University (Sechenov University)

D. O Zubacheva

Sechenov First Moscow State Medical University (Sechenov University)

ординатор 1-го года каф. внутренних, профессиональных болезней и ревматологии; ORCID 0000-0001-8020-7041 Sechenov First Moscow State Medical University (Sechenov University)

N. V Tchebotareva

Sechenov First Moscow State Medical University (Sechenov University)

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии; ORCID 0000-0003-2128-8560 Sechenov First Moscow State Medical University (Sechenov University)

V. V Kozlov

Sechenov First Moscow State Medical University (Sechenov University)

доц. каф. общественного здоровья и организации здравоохранения; ORCID: 0000-0002-2389-3820 Sechenov First Moscow State Medical University (Sechenov University)

A. M Kuchieva

Sechenov First Moscow State Medical University (Sechenov University)

врач отделения нефрологии и гемодиализа; ORCID: 0000-0002-8360-7734 Sechenov First Moscow State Medical University (Sechenov University)

O. A Li

Sechenov First Moscow State Medical University (Sechenov University)

ассистент каф. внутренних, профессиональных болезней и ревматологии, врач отделения нефрологии и гемодиализа; ORCID: 0000-0003-1739-677Х Sechenov First Moscow State Medical University (Sechenov University)

V. A Reshetnikov

Sechenov First Moscow State Medical University (Sechenov University)

д.м.н., проф. каф. общественного здоровья и организации здравоохранения; ORCID 0000-0002-2987-7995 Sechenov First Moscow State Medical University (Sechenov University)

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