Nutrition and chronic renal failure in rats: what is an optimal dietary protein?

In chronic uremia (CRF), malnutrition is an important determinant of morbidity in adults and impaired growth in children. Causes of malnutrition include anorexia and abnormal protein and amino acid metabolism. To determine how different levels of dietary protein and CRF interact to influence growth and nutritional status, CRF and sham-operated, pair-fed control rats were fed isocaloric diets containing 8, 17, or 30% protein for 21 d to mimic dietary regimens recommended for CRF patients: the minimum daily requirement; the recommended daily allowance; or an excess of dietary protein. Serum creatinine did not differ between groups of CRF rats but blood urea nitrogen was lowest in CRF rats fed 8% protein (P < 0.001). CRF rats eating 30% protein gained less weight and length compared to their controls or CRF rats fed 8 or 17% protein (P < 0.05); they also had acidemia. CRF rats fed 8% protein had the highest efficiency of utilization of protein for growth, while 17% protein promoted the highest efficiency of utilization of food and calories for growth. Notably, CRF rats eating 30% protein had the lowest protein efficiency; their calorie intake was also the lowest because of anorexia. Plasma branched-chain amino acids were progressively higher in control rats eating 8, 17, or 30% protein. CRF rats fed 8 or 17% protein had lower branched-chain amino acid concentrations compared with CRF rats fed 30% protein. In CRF, it is concluded that excessive dietary protein impairs growth but a low-protein diet does not impair nutritional responses and permits utilization of protein for growth if calories are sufficient.

[1]  W. Mitch,et al.  Should protein intake be restricted in predialysis patients? , 1999, Kidney international.

[2]  Xiaonan H. Wang,et al.  Tissue-specific responses of branched-chain alpha-ketoacid dehydrogenase activity in metabolic acidosis. , 1998, Journal of the American Society of Nephrology : JASN.

[3]  J. Wernerman,et al.  Correction of acidosis in dialysis patients increases branched-chain and total essential amino acid levels in muscle. , 1997, Clinical nephrology.

[4]  J. Kopple.  McCollum Award Lecture, 1996: protein-energy malnutrition in maintenance dialysis patients. , 1997, The American journal of clinical nutrition.

[5]  K. Kalantar-Zadeh,et al.  Nutritional management of renal disease , 1997 .

[6]  W. Mitch,et al.  Role of nutrition in prevention of the progression of renal disease. , 1997, Annual review of nutrition.

[7]  P. Södersten,et al.  Middle-sized molecule fractions isolated from uremic ultrafiltrate and normal urine inhibit ingestive behavior in the rat. , 1996, Journal of the American Society of Nephrology : JASN.

[8]  W. Lamers,et al.  Response of hepatic amino acid consumption to chronic metabolic acidosis. , 1996, The American journal of physiology.

[9]  P. Södersten,et al.  Influence of peritoneal dialysis solutions with glucose and amino acids on ingestive behavior in rats. , 1996, Kidney international.

[10]  A. Levey,et al.  Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study. , 1996, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[11]  W. Mitch,et al.  The acidosis of chronic renal failure activates muscle proteolysis in rats by augmenting transcription of genes encoding proteins of the ATP-dependent ubiquitin-proteasome pathway. , 1996, The Journal of clinical investigation.

[12]  W. Mitch,et al.  Glucocorticoids and acidosis stimulate protein and amino acid catabolism in vivo. , 1996, Kidney international.

[13]  J. Vadgama,et al.  Impaired actions of insulin-like growth factor 1 on protein Synthesis and degradation in skeletal muscle of rats with chronic renal failure. Evidence for a postreceptor defect. , 1996, The Journal of clinical investigation.

[14]  V. Young,et al.  Long-term adaptive responses to dietary protein restriction in chronic renal failure. , 1995, The American journal of physiology.

[15]  P. Södersten,et al.  Diet-independent suppression of ingestive behavior by cholecystokinin octapeptide and amino acids. , 1995, The American journal of physiology.

[16]  R. Hakim.  Initiation of dialysis. , 1994, Advances in nephrology from the Necker Hospital.

[17]  P. G. Reeves,et al.  AIN-93 purified diets for laboratory rodents: final report of the American Institute of Nutrition ad hoc writing committee on the reformulation of the AIN-76A rodent diet. , 1993, The Journal of nutrition.

[18]  C. Scrimgeour,et al.  Correction of acidosis in humans with CRF decreases protein degradation and amino acid oxidation. , 1993, The American journal of physiology.

[19]  D. Forget,et al.  Supplemented low-protein diets protect the rat kidney without causing undernutrition. , 1992, The Journal of laboratory and clinical medicine.

[20]  O. Mehls,et al.  Multicentre randomized study on the effect of a low-protein diet on the progression of renal failure in childhood: one-year results. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. , 1992, Mineral and electrolyte metabolism.

[21]  T. Mochizuki.  [The effect of metabolic acidosis on amino acid and keto acid metabolism in chronic renal failure]. , 1991, Nihon Jinzo Gakkai shi.

[22]  E G Lowrie,et al.  Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. , 1990, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[23]  R. Tazzari,et al.  Growth in uremic children. , 1988, Contributions to nephrology.

[24]  W. Mitch,et al.  Nutrition and the kidney , 1988 .

[25]  W. Mitch,et al.  Acidosis, not azotemia, stimulates branched-chain, amino acid catabolism in uremic rats. , 1987, Kidney international.

[26]  W. Mitch,et al.  Branched-chain amino acid metabolism in rat muscle: abnormal regulation in acidosis. , 1987, The American journal of physiology.

[27]  W. Mitch,et al.  Mechanisms for defects in muscle protein metabolism in rats with chronic uremia. Influence of metabolic acidosis. , 1987, The Journal of clinical investigation.

[28]  B. Lacour,et al.  Role of amount and nature of carbohydrates in the course of experimental renal failure. , 1986, Kidney international.

[29]  J. Kopple,et al.  Effect of energy intake on nitrogen metabolism in nondialyzed patients with chronic renal failure. , 1986, Kidney international.

[30]  A. Williams,et al.  PROTEIN RESTRICTION IN CHRONIC RENAL FAILURE , 1985, The Lancet.

[31]  W. Arnold,et al.  Effects of caloric supplementation on growth in children with uremia. , 1983, Kidney international.

[32]  J. Knochel.  The Pathophysiology of Uremia , 1981 .

[33]  M. Gubler,et al.  Prolonged renal survival and stunting, with protein-deficient diets in experimental uremia. Reversal of these effects by addition of essential amino acids. , 1981, The Journal of laboratory and clinical medicine.

[34]  M. Gubler,et al.  Effect of various protein diets on growth, renal function, and survival of uremic rats. , 1979, Kidney international.

[35]  D. Thissen,et al.  Measurement of growth in children with renal insufficiency. , 1978, Kidney International.

[36]  R. Morris,et al.  Attainment and maintenance of normal stature with alkali therapy in infants and children with classic renal tubular acidosis. , 1978, The Journal of clinical investigation.

[37]  M. Swendseid,et al.  Effect of protein intake on weight gain and plasma amino acid levels in uremic rats. , 1976, The American journal of physiology.

[38]  M. Broyer,et al.  Growth in experimental renal failure: role of calorie and amino acid intake. , 1975, Kidney international.

[39]  P. Betts,et al.  Growth Pattern and Dietary Intake of Children with Chronic Renal Insufficiency , 1974, British medical journal.

[40]  M. Holliday,et al.  Relation of calorie deficiency to growth failure in children on hemodialysis and the growth response to calorie supplementation. , 1971, The New England journal of medicine.

[41]  G. Jørgensen.  Energy and protein requirements of mink. , 1967 .

[42]  S. Lionel,et al.  Kidney Diseases, Urinary Deposits, and Calculous Disorders: Their Nature and Treatment , 1869, The British and foreign medico-chirurgical review.