Teplan V, Schück O, Knotek A, Hajný J, Horácková M, Skibová J, Malý J
Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine and Chain of Nephrology, Postgraduate Medical School, Prague, Czech Republic.
Ann Transplant. 2001;6(1):47-53.
Ketoacids (KA) and recombinant human erythropoietin (rHuEPO) may each, on their own, influence the metabolic status of patients with chronic renal failure (CRF). A long-term prospective randomized study was designed to monitor the metabolic and nutritional status and progression of CRF using three therapeutic protocols: (A) low-protein diet (LPD) with 0.6 g of protein and 35 kcal/kg/day, with recombinant human erythropoietin (rHuEPO) at a dose of 40 U kg/week and keto acids (KA) 100 mg/kg/day, (Group I), (B) LPD and rHuEPO (Group II), and (C) LPD only (Group III). A total of 105 patients (50M/55F), aged 26-78 years, CCr 22-36 ml/min, were monitored at the beginning, and at every 6 months for 3 years in the above three study groups. Group I comprised 35 patients, Group II 38 patients and Group III 32 patients. During follow-up, a significantly smaller decrease in GFR (CCr, Cin) and in I/SCr, and an increase in serum albumin, transferrin, leucine, body mass, index and HDL-cholesterol were found in Group I (all p < 0.01). In addition, significant decreases were also seen in proteinuria, renal fractional leucine excretion and serum triglycerides level (p < 0.01). Co-administration of LPD, rHuEPO and KA thus constitutes an effective alternative to conservative management of CRF, delaying in follow-up period progression of renal failure and correction of metabolic parameters.
酮酸（KA）和重组人促红细胞生成素（rHuEPO）各自都可能影响慢性肾衰竭（CRF）患者的代谢状态。一项长期前瞻性随机研究旨在通过三种治疗方案监测CRF患者的代谢和营养状况以及病情进展：（A）低蛋白饮食（LPD），蛋白质摄入量为0.6 g，能量为35 kcal/kg/天，联合剂量为40 U/kg/周的重组人促红细胞生成素（rHuEPO）和100 mg/kg/天的酮酸（KA）（第一组），（B）LPD和rHuEPO（第二组），以及（C）仅LPD（第三组）。共有105例患者（50例男性/55例女性），年龄在26至78岁之间，内生肌酐清除率（CCr）为22至36 ml/min，在研究开始时以及上述三个研究组中每6个月监测一次，为期3年。第一组有35例患者，第二组有38例患者，第三组有32例患者。在随访期间，第一组的肾小球滤过率（CCr、Cin）和I/SCr的下降明显较小，血清白蛋白、转铁蛋白、亮氨酸、体重指数和高密度脂蛋白胆固醇增加（所有p<0.01）。此外，蛋白尿、肾脏亮氨酸排泄分数和血清甘油三酯水平也显著下降（p<0.01）。因此，联合使用LPD、rHuEPO和KA是CRF保守治疗的有效替代方案，可延缓随访期间肾衰竭的进展并纠正代谢参数。
