Suplemented restricted diet in old patients with chronic renal disease

Authors: Vladimír Teplan 1,2
Authors‘ workplace: Subkatedra nefrologie IPVZ, Praha 1;  Interní klinika LF OU, Ostrava 2
Published in: Vnitř Lék 2016; 62(Suppl 6): 88-96
Category: Reviews


In last decades was confirmed remarkable increase in number of old patients with chronic kidney disease. Despide of developments in dialysis technology and kidney transplantation there is a growing number of old patients who are not suitable for these methods. Recently were published data showing long-term effect of protein restricted diet supplemented with keto amino acids in elderly. Based on our results obtained in re-analysis of 3 000 patients we can confirm also good compliance and low risk of malnutrition.

Key words:
chronic kidney disease – keto amino acids – old age – restricted diet


1. Darmon P, Kaiser JM, Bauer JM et al. Restrictive diet in the elderly: Never say never again. Clin Nutr 2010; 29(2): 170–174. Dostupné z DOI: <>.

2. El Nahas AM, Bello AK. Chronic kidney disease: the global chalenge. Lancet 2005; 365(9456): 331–340.

3. Brunori G, Viola BF, Parrinello G et al. 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(5): 569–580.

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

5. Schück O. Examination of kidney function. Martinus Nijhoff Publishers: Boston 1984: 218–227.ISBN 978–94–010–8997–5.

6. Klahr S, Harris K. Adaptation of remnant nephrons. In: Giovannetti J (ed). Nutritional treatment of chronic renal failure. Kluwer Academic Publishers 1989: 21–28. ISBN 978–0-7923–0086–1.

7. Teplan V et al. Nefrologie vyššího věku. Mladá fronta [Aesculap]: Praha: 2015. 263–277. ISBN 978–80–204–3521–7.

8. Piccoli GB, Attini R, Vasario E et al. Vegetarian supplemeted low-protein diets. A safe option for pregnant CKD patiens: report of 12 pregnancies in 11 patients. Nephrol Dial Transplant 2011; 26(1): 196–205. Dostupné z DOI: <>.

9. Aparicio M, Bellizzi V, Chauveau P et al. Keto acid therapy in predialysis chronic kidney disease patients: final consensus. J Ren Nutr 2012; 22(Suppl 2): S22-S24. Dostupné z DOI: <>.

10. Teplan V. Pharmacological features of a keto amino acids. Am J Nephrol 2005; 25(Suppl 1): S13-S14.

11. Fouque D, Laville M, Boissel JP et al. Controlled low protein diets in chronic renal insufficiency: meta-analysis. BMJ 1992; 304(6821): 216–220.

12. Teplan V. Metabolismus a ledviny. Grada: Praha 2000: 35–47. ISBN 80–7169–731–1.

13. Mitch WE. Beneficial responses to modified diets in treating patients with chronic kidney disease.. Kidney Int 2005; 67(Suppl 94): S133-S135.

14. Misra M, Nolph K. Efficacy and safety of very-low-protein diet in the elderly: what are the options? Am J Kidney Disease 2008; 51(3): 530. Dostupné z DOI: <>.

15. Toigo G, Aparicio M, Attman PO et al. Expert Working Group report on nutrition in adults patients with renal insufficiency (part 1 of 2). Clin Nutr 2000; 19(3): 197–207.

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

17. Teplan V. Effect of keto acids on asymmetric dimethylarginine, muscle, and fat tissue in chronic kidney disease and after kidney transplantation. J Ren Nutr 2009; 19(5 Suppl): S27-S29.

18. Teplan V, Schück O, Knotek A et al. Enhanced metabolic effect of erythropoietin and keto acids in CRF patients on low-protein diet: Czech multicenter study. Am J Kidney Dis 2003; 41(3 Suppl 1): S26-S30.

19. Stenvikel P, Fröbet O, Anderstam B et al. Metabolic changes in summer active and anuric hiberneting free-ranging brown bears (Ursus arctos). PLoS One 2013; 8(9): e72934. Dostupné z DOI: <>.

20. 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(3): 245–251.

21. Cupisti A, Ghiadoni L, D´Alessandro C et al. Soy protein diet improves endothelial dysfunction in renal transplant patients. Nephrol Dial Transpl 2007; 22(1): 229–234.

22. Pan Y, Guo LL, Jin HM. Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2008; 88(3): 660–666.

23. Brenner BM, Meyer TW, Hostetter TH. Dietary protein intake and progressive nature of kidney disease. N Engl J Med 1982; 307(11): 652–660.

24. Apparicio M, Bellizi V, Chauveau P et al. Do ketoanalogues still have a role in delaying dialysis initiation in CKD predialysis patients? Semin Dial 2013; 26(6): 714–719. Dostupné z DOI: <>.

25. Chauveau P, Vendrely B, Haggan WE et al. Body composition of patients on a very low-protein diet. Two – year surfy with DEXA. J Ren Nutr 2003; 13(4): 282–287.

26. 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): S8-S10.

27. Teplan V, Schück O, Malý J et al. Konzervativní léčení chronické renální insuficience (CKD 4–5) u seniorů. Aktuality v nefrologii 2010; 16(2): 59–66.

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