Konzervativní léčení seniorů s chronickým onemocněním ledvin ve stadiu CKD 3b a vyšším

Authors: V. Teplan;  E. Topinková
Published in: Geriatrie a Gerontologie 2017, 6, č. 1: 16-22
Category: Review Article


In last decades remarkable increase in numbers of old patients with chronic kidney disease was confirmed. Despite new developments in dialysis technology and kidney transplantation there is a growing number of patients with chronic comorbidities and disabilities for whom these methods are not preferable. Recently published data show long – term effect of protein restricted diet supplemented with keto amino acids. Conservative management therefore can remarkably increase prognosis and quality of life for these high risk renal patients in stage C3b and higher.

chronic kidney disease – conservative management– low protein diet – keto amino acids


1. Brunori G. Efficacy and safety of very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am J Kidney Dis 2007; 49: 569–580.

2. Brunori G. How manage elderly patients with chronic renal failure. conservative management versus dialysis. Blood Purif 2008, 26: 36–40.

3. Schück O. Examination of kidney function, Martinus Nijhoff Publishers l984; 218–227.

4. Bellizzi V, Di Iorio BR, De Nicola L, et al. Very low protein diet supplemented with ketoanalogues improves blood pressure control in chronic kidney disease. Kidney Int 2007; 71: 245–251.

5. Nesins M, Bright M. Cockcroft. Gault formula for diagnosis of moderate kidney failure. J Am Geriatr Soc 2008; 56(4): 774–776.

6. Chauveau P, Vendrely B, Haggan WE, et al. Body composition of patients on a very low-protein diet. Two-year survey with DEXA. J Ren Nutr 2003; 13: 282–287.

7. Cianciaruso M, Lucidi P, Ciarambino T, et al. Metabolic effects of two low-protein diet in chronic kidney disease stage 4–5: a randomized controlled trial. Nephol Dial Transpl 2007; 23: 636–644.

8. Teplan V. Metabolismus a ledviny. Grada Publishing 2000; s. 412.

9. Teplan V. Keto/amino acids in the treatment of chronic kidney disease patients: 30 years experience in 3,000 patients. Am J Nephrol 2005; 25(suppl 1): 8–10.

10. Nádvorníková H. Koncentrační schopnost ledvin. Praha: Avicenum 1983.

11. Oreopoulos DG, Dimkovic N. Geriatric nephrology is coming of age, J Am Soc Nephrol 2003; 14 (4): 1099–1101.

12. Musso CG. Geriatric nephrology and the “nephrogeriatric giants”. Int Urol Nephrol 2002; 34 (2): 255–256.

13. Apparicio M, Chauveau P, de Precigout V, et al. Nutrition and outcome on renal replacement therapy of patients with chronic renal failure treated by supplemented very low-protein diet. J Am Soc Nephol 2000; 12: 708–711.

14. Misra M, Nolph K. Efficacy and safety of very-low-protein diet in the elderly: what are the options? Am J Kidney Dis 2008; 51(3): 530–531.

15. Cupisti A, Ghiadoni L, D´Alessandro C, et al. Soy protein diet improves endothelial dysfunction in renal transplant patients. Nephrol Dial Transpl 2007; 22: 229–234.

16. Brenner BM, Meyer TW, Hostetter TH. Dietary protein intake and progressive nature of kidney disease. New Engl J Med 1982; 307: 652–660.

17. Klahr S, Harris K. Adaptation of remnant nephrons. In Nutritional treatment of chronic renal failure, eds. Giovannetti, Kluwer Academic Publishers l989; 21–8.

18. Mitch WE. Beneficial response to modified diets in treating patients with chronic kidney disease. Kidney Int 2005; Suppl 94: 133–135.

19. Aparicio M, Bellizzi V, Chauveau P, et al. Keto acid therapy in predialysis chronic kidney disease patiens:final consensus. J Ren Nutr 2012; 22(Suppl 2): S22–24.

20. Teplan V, Schück O, Racek J, et al. Reduction of plasma asymmetric dimethylarginine in obese patiens with chronic kidney disease after three years of low-protein diet supplemented with keto-amino acids: a randomized controlled trial. Wien Klin Wochenschr 2008; 120(15–16): 478–485.

21. Lin S. Low-protein diets and keto analogues: current research projects in China. Am J Nephrol (Suppl1) 2006: 15.

22. Fouque D, Laville M, Boissel JP. Low protein diets for chronic kidney disease in nondiabetic adults. Cochrane Database Syst Rev 2006, 19: CD 001892.

23. Toigo G, Aparicio M, Attman PO, et al. Consensus report: Expert Working Group report on nutrition in adults patients with renal insufficiency (part 1 of 2). Clin Nutr 2000, 19(3): 145–212.

24. Toigo G, Aparicio M, Attman PO, et al. Consensus report: Expert Working Group report on nutrition in adults patients with renal insufficiency (part 2 of 2), Clin Nutr 2000; 19(4): 281–291.

25. Teplan V. Pharmacological features of keto amino acids. Am J Nephrol 2005; 25(suppl 1): 13–14.

26. Teplan V. Standards of care for diabetic nephropathy. Am J Nephrol 2005; 25(suppl 1): 18–21.

27. Pan Y, Guo LL, Jin HM. Low-protein diet for diabetic nephropathy: a meta-anylasis of randomized controlled trials. Am J Clin Nutr 2008; 88: 660–666.

28. Zakar G. Metabolic effects of branched-chain amino acids and keto acids: mechanisms independent of protein intake? J Ren Nutr 2009; Suppl 1: 25–26.

29. Teplan V. Suplementované restriktivní diety u nemocných vyššího věku s chronickým onemocněním ledvin. Vnitřn Lék 2016; 12(Suppl 6): 88–96.

30. Fouque D, Chen J, Chen W, et al. Adherence to ketoacids/essential amino acids-supplemented low protein diet and new indications for patients with chronic kidney disease. BMC Nephrology 2016; 17: 63–64.

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