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Journal of Chinese Integrative Medicine ›› 2008, Vol. 6 ›› Issue (5): 473-477.doi: 10.3736/jcim20080508

• Original Clinical Research • Previous Articles     Next Articles

Effects of low-protein diet plus α-keto acid on micro-inflammation and the relationship between micro-inflammation and nutritional status in patients performing continuous ambulatory peritoneal dialysis: a randomized controlled trial

Wei Chen, Zhi-yong Guo(), Hao Wu, Li-jing Sun, Li-li Cai, Hai-yan Xu   

  1. Department of Nephrology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
  • Received:2008-03-14 Online:2008-05-20 Published:2008-05-15
  • Contact: GUO Zhi-yong E-mail:zhiyong_guo@126.com

Objective: To investigate the effects of the combination of α-keto acid and low-protein diet on the levels of serum cytokines in patients performing continuous ambulatory peritoneal dialysis (CAPD) and to explore the relationship between inflammation and malnutrition in CAPD patients.
Methods: Eighty-nine CAPD patients were randomized into three groups, and 78 cases completed a one-year follow-up and with complete data. There were 31 cases in low-protein diet plus α-keto acid group, 26 cases in low-protein diet group and 21 cases in routine-protein diet group. The levels of serum albumin (Alb), prealbumin (PA), retinol-binding protein (RBP), transferrin (TRF), cholesterol (TC), triglycerides (TG), leptin, and triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), body mass index (BMI) were measured. The changes of serum interleukin-1α (IL-1α), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were also detected.
Results: Compared with low-protein diet group, serum levels of PA, RBP and TRF were significantly increased both in low-protein diet plus α-keto acid and routine-protein diet groups (P<0.01), however, there was no significant difference in the levels of PA, RBP and TRF between low-protein diet plus α-keto acid group and routine-protein diet group. There was an increased tendency in the content of Alb, TC, TG, BMI, TSF and MAMC, but there were no significant differences. The plasma levels of IL-1α, IL-6 and TNF-α in low-protein diet plus α-keto acid group were decreased as compared with the routine-protein diet group, but there were no significant differences. The plasma level of CRP in low-protein diet plus α-keto acid group was lower than that in the routine-protein diet group (P<0.01).
Conclusion: The combination of α-keto acid and low-protein diet can ameliorate malnutrition and micro-inflammation in CAPD patients.

Key words: low-protein diet, keto-acids, peritoneal dialysis, inflammation, malnutrition

CLC Number: 

  • R459.51

Table 1

General data in three groups"

Baseline data Routine-protein diet
(n=21)
Low-protein diet
(n=26)
Low-protein diet plus α-keto acid
(n=31)
Age ($\bar{x}$±s, years) 68.7±15.9 64.1±10.7 67.2±12.5
Male/Female 12/9 15/11 18/13
Duration of peritoneal dialysis($\bar{x}$±s,months) 34.7±19.6 29.5±20.1 31.3±24.8
Diabetic patient (%) 19.0 (4/21) 11.5 (3/26) 16.1 (5/31)
BMI ($\bar{x}$±s, kg/m2) 25.36±6.13 22.14±2.19 23.97±3.02
Urine volume ($\bar{x}$±s, ml/d) 993±289 1 190±478 1 067±325
BUN ($\bar{x}$±s, mmol/L) 14.07±5.33 13.41±6.76 11.23±5.91
SCr ($\bar{x}$±s, μmol/L) 845.52±120.87 812.46±157.91 782.09±211.37
Amino acids ($\bar{x}$±s, mg/L) 359.0±143.5 341.7±115.4 353.2±141.9
Energy intake [$\bar{x}$±s, kcal/(kg·d)] 1 709±1 045 1 671±723 1 878±821
nPNA [$\bar{x}$±s, g/(kg·d)] 1.03±0.35 0.77±0.21 0.81±0.19
Alb ($\bar{x}$±s, g/L) 35.7±6.3 33.1±4.5 34.1±6.1
PA ($\bar{x}$±s, mg/L) 178.1±81.9 191.4±69.6 181.5±73.2
Urea Kt/V ($\bar{x}$±s) 1.78±0.33 1.81±0.21 1.85±0.56
Ccr [x±s, L/(week·1.73 m2)] 85.2±17.7 83.4±16.9 87.3±21.2
EPO dosage ($\bar{x}$±s, kU/week) 6.02±1.98 6.13±2.16 6.08±2.01
TC ($\bar{x}$±s, mmol/L) 4.56±1.84 4.34±1.11 4.98±1.23
TG ($\bar{x}$±s, mmol/L) 1.48±0.61 1.21±0.40 1.32±0.56
TSF ($\bar{x}$±s, mm) 23.10±5.67 20.44±6.02 22.77±7.12
MAMC ($\bar{x}$±s, mm) 20.11±2.78 18.21±3.26 19.34±2.15
RBP ($\bar{x}$±s, mg/L) 16.4±8.2 18.4±7.1 17.2±9.7
TRF ($\bar{x}$±s, mg/L) 1.79±1.34 1.67±0.56 1.41±1.34
Leptin ($\bar{x}$±s, μg/L) 51.1±17.3 49.3±19.1 53.2±19.4

Table 2

(to be continued) Changes of nutritional status in CAPD patients before and after treatment in three groups ($\bar{x}$±s)"

Group n BMI (kg/m2) SCr (μmol/L) Alb (g/L) TC (mmol/L) TG (mmol/L)
Routine-protein diet
Pre-treatment 21 25.36±6.13 845.52±120.87 35.7±6.3 4.56±1.84 1.48±0.61
Post-treatment 21 27.03±7.78 879.23±112.84**△△ 37.2±7.7 5.71±2.21 1.83±0.92
Low-protein diet
Pre-treatment 26 22.14±2.19 812.46±157.91 33.1±4.5 4.34±1.11 1.21±0.40
Post-treatment 26 24.12±4.39 714.61±145.09 34.1±6.5 4.96±1.61 1.53±0.56
Low-protein diet plus α-keto acid
Pre-treatment 31 23.97±3.02 782.09±211.37 34.1±6.1 4.98±1.23 1.32±0.56
Post-treatment 31 25.86±5.23 838.17±216.83**△△ 36.4±7.7 5.35±1.40 1.72±0.78
Group n TSF (mm) MAMC (mm) RBP (mg/L) PA (mg/L) TRF (mg/L) Leptin (μg/L)
Routine-protein diet
Pre-treatment 21 23.10±5.67 20.11±2.78 16.4±8.2 178.1±81.9 1.79±1.34 51.1±17.3
Post-reatment 21 25.11±7.24 23.22±4.90 33.3±12.1** 291.4±101.6** 3.98±1.55** 33.1±27.1**
Low-protein diet
Pre-treatment 26 20.44±6.02 18.21±3.26 18.4±7.1 191.4±69.6 1.67±0.56 49.3±19.1
Post-reatment 26 22.80±7.10 20.17±3.37 19.1±5.9 210.4±91.9 1.92±0.73 47.9±31.5
Low-protein diet plus α-keto acid
Pre-treatment 31 22.77±7.12 19.34±2.15 17.2±9.7 181.5±73.2 1.41±1.34 53.2±19.4
Post-reatment 31 24.78±8.16 21.34±3.58 31.8±11.7** 282.7±87.2** 3.11±1.14** 37.5±27.1**

Table 3

Changes of serum inflammation cytokines in CAPD patients before and after treatment in three groups ($\bar{x}$±s)"

Group n IL-1α (ng/L) IL-6 (ng/L) TNF-α (ng/L) CRP (mg/L)
Routine-protein diet
Pre-treatment 21 36.09±13.19 11.99±1.43 167.55±62.65 17.88±10.79
Post-treatment 21 31.56±13.33 7.08±2.81 123.40±10.99 9.12±5.08**
Low-protein diet
Pre-treatment 26 37.33±9.77 11.02±3.79 140.78±43.09 19.51±7.33
Post-treatment 26 35.64±10.78 9.34±4.56 129.02±59.55 16.21±2.39
Low-protein diet plus α-keto acid
Pre-treatment 31 39.41±11.23 12.67±7.21 154.89±78.11 15.76±4.45
Post-treatment 31 33.40±12.81 8.19±6.35 117.78±56.77 8.80±3.67**
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