Teplan Vladimír, Schück Otto, Knotek Antonín, Hajný Jan, Horácková Miroslava, Kvapil Milan
Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Am J Kidney Dis. 2003 Mar;41(3 Suppl 1):S26-30. doi: 10.1053/ajkd.2003.50079.
Our study is designed to establish whether supplementation with erythropoietin (EPO) exerts additional beneficial metabolic effects in patients with chronic renal failure (CRF) treated with keto acids (KAs) on a low-protein diet (LPD).
A long-term, prospective, randomized study was designed to use three therapeutic protocols: (A) EPO plus KAs plus LPD (group I), (B) EPO plus LPD (group II), and (C) LPD (group III). One hundred eighty-six randomly selected patients (90 men, 96 women; age, 22 to 78 years) with a creatinine clearance of 22 to 36 mL/min were monitored at the beginning and at every 6 months for 3 years.
During the study period, glomerular filtration rate measured as inulin clearance decreased slightly (from 26.2 +/- 3.4 to 23.4 +/- 4.1 mL/min in group I), 27.4 +/- 4.8 to 20.2 +/- 4.4 mL/min in group II, and 26.8 +/- 3.6 to 17.4 +/- 4.1 mL/min in group III; P < 0.01). Serum urea levels also declined (P < 0.01), more pronouncedly in group I (P < 0.025). In group I, there was a significant increase in levels of leucine (P < 0.01) and albumin (P < 0.01) and a decrease in proteinuria (P < 0.01). Analysis of the lipid spectrum showed a mild, yet significant, decrease in total cholesterol and low-density lipoprotein cholesterol levels (P < 0.025), more pronounced in group I. In group I, there was a decrease in plasma triglyceride levels (from 362.85 +/- 115.05 mg/dL [4.1 +/- 1.3 mmol/L] to values as low as 203.55 +/- 70.80 mg/dL [2.3 +/- 0.8 mmol/L]; P < 0.01), whereas high-density lipoprotein cholesterol levels increased (from 34.75 +/- 7.72 mg/dL [0.9 +/- 0.2 mmol/L] to 46.33 +/- 7.72 mg/dL [1.2 +/- 0.2 mmol/L]; P < 0.025). Mean arterial blood pressure was stable.
EPO supplementation in patients with CRF administered KAs potentiates the beneficial effects on metabolism of proteins, amino acids, and lipids. Long-term coadministration of EPO, KA, and LPD was associated with a delay in progression of renal failure and reduction in proteinuria.
我们的研究旨在确定在接受低蛋白饮食（LPD）并服用酮酸（KAs）治疗的慢性肾衰竭（CRF）患者中，补充促红细胞生成素（EPO）是否会产生额外的有益代谢作用。
一项长期、前瞻性、随机研究设计了三种治疗方案：（A）EPO加KAs加LPD（I组），（B）EPO加LPD（II组），以及（C）LPD（III组）。对186例随机选择的患者（90例男性，96例女性；年龄22至78岁）进行研究，其肌酐清除率为22至36 mL/min，在研究开始时以及每6个月监测一次，为期3年。
在研究期间，以菊粉清除率衡量的肾小球滤过率略有下降（I组从26.2±3.4降至23.4±4.1 mL/min），II组从27.4±4.8降至20.2±4.4 mL/min，III组从2
