To investigate the effects of a low-protein diet (LPD) in chronic renal failure (CRF), muscle biopsies were performed on eight nondialyzed patients before and after 1 year of reduced protein intake (0.5 g/kg/d) with calorie intake equal to 1.4 x resting energy expenditure (1.4 x REE). Serum parathormone, glucagon, insulin levels, blood HCO3-, and pH were measured before and after LPD. The bicycle exercise test also was performed to evaluate exercise tolerance. The control group consisted of 12 healthy sedentary subjects matched for sex, age, and weight. Twelve months of LPD caused an increase in muscle adenosine triphosphate (ATP) concentration (p .001) and a reduction both in citrate (p < .05) and α-ketoglutarate (p < .05) concentrations. Citrate synthase (p < .05) and alanine aminotransferase (p < .05) activities decreased. No significant changes were noted in hormonal and blood acid-base status. Patients with CRF reported reduced muscle weakness during physical activity after 1 year of LPD: their oxygen consumption (Vo2) peak and Vo2/heart rate (HR) (oxygen pulse) were significantly higher. Our study revealed that 1 year of dietary intake with calories equal to 1.4 x REE can reduce, but not normalize the alterations in muscle energy metabolism due to CRF.
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References
1.
1. Lazaro RP, Kirshner HS.Proximal muscle weakness in uremia. Case reports and review of the literature. Arch Neurol1980;37:555–86.
2.
2. Metcoff J, Lindeman R, Daxter B, et al. Cell metabolism in uremia. Am J Clin Nutr1978;31:1627–34.
3.
3. Brautbar N. Skeletal myopathy in uremia: abnormal energy metabolism. Kidney Int1983;24(Suppl 16):S81–6.
4.
4. Del Canale S, Fiaccadori E, Coffrini E, et al. Uremic acidosis and intracellular buffering. Scand J Urol Nephrol1986;20:301–6.
5.
5. Pastoris O, Aquilani R, Foppa P, et al. Altered muscle energy metabolism in post-absortive patients with chronic renal failure. Scand J Urol Neprol1997;31:281–7.
6.
6. Barany P, Wibom R, Hultman E, et al. ATP production in isolated muscle mitochondria from haemodialysis patients: effects of correction of anaemia with erythropoietin. Clin Sci1991;81:645–53.
7.
7. De Fronzo RA, Alvestrand A, Smith D, et al. Insulin resistance in uremia. J Clin Invest1981;67:563–8.
9. Bak JF, Schmitz O, Sorensen SS, et al. Activity of insulin receptor kinase and glycogen synthase in skeletal muscle from patients with chronic renal failure. Acta Endocrinol Copenh1989;121:744–50.
10.
10. Horl WH, Heidland A.Glycogen metabolism in uremia. Am J Clin Nutr1980;33:1461–7.
11.
11. Fiaschi E, Campanacci L, Guarnieri GF, et al. Muscle glucose content and hexokinase activity in patients with chronic uremia. Kidney Int1975;7:S341–4.
12.
12. Guarnieri G, Toigo G, De Marchi S, et al. Muscle hexokinase and phosphofructokinase activity in chronically uremic patients. In: Giordano C, Friedman EA, eds. Uremia: pathobiology of patients tested for 10 years or more. Milano: Wichting, 1981;278–82.
13.
13. Dzurik R. The pathophysiology of carbohydrate metabolism. Bratislava, Publishing House of the Slovak Academy of Sciences, 1973.
14.
14. Contreras I, Caro FJ, Aveledo L, et al. Chronic uremia, insulin activates receptor kinase but not pyruvate dehydrogenase. Nephron1992;61:77–81.
15.
15. Yamakawa M, Yamamoto T, Kishimoto T, et al. Serum levels of acetate and TCA cycle intermediates during hemodialysis in relation to symptoms. Nephron1982;32:155–61.
16.
16. Biasioli S, Ferian M, Bigi L, et al. Tricarboxylic acid cycle intermediates in chronic renal failure. Nephrol Dial Transplant1987;2:313–5.
17.
17. Conjard A, Ferrier B, Martin M, et al. Effects of chronic renal failure on enzymes of energy metabolism in individual human muscle fibers. J Am Soc Nephrol1995;6:68–74.
18.
18. Aquilani R, Bovio G, Segagni S, et al. Il dispendio energetico a riposo in pazienti con insufficienza renale cronica. Riv Ital Nutr Parent Ent1994;12:151–6.
19.
19. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes1979;28:1039–57.
20.
20. Bergström J.Muscle electrolytes in man. Determined by neutron activation analysis on needle biopsy specimens. A study on normal subjects, kidney patients, and patients with chronic diarrhoea. Scand J Clin Lab Invest1962; 14 (Suppl 68):1–110.
21.
21. Pastoris O, Dossena M, Vercesi L, et al. Biochemical changes induced in the myocardial cell during cardioplegic arrest supplemented with creatine phosphate. J Cardiothor Vasc Anesth1991;5;475–80.
22.
22. Lowry OH, Rosebrough NJ, Farr AL, et al. Protein measurement with the folin phenol reagent. J Biol Chem1951;193:265–75.
23.
23. Tabelle di composizione degli alimenti. Istituto Nazionale della Nutrizione, 1989.
24.
24. Kopple JD, Nonteon EJ, Shaib JK.Effect of energy intake on nitrogen metabolism in nondialyzed patient with chronic renal failure. Kidney Int1986;29:734–42.
25.
25. Ferranini E. The theoretical bases of indirect calorimetry: a review. Metabolism1988;37:287–301.
26.
26. Frayn KN.Calculation of substrate oxidation rates in vivo from gaseous exchange. J Appl Physiol1983;55:626–34.
27.
27. Grödstein GP, Kopple JD.Urea nitrogen appearance, a simple and practical indicator of total nitrogen output. Kidney Int1979;16:953–8.
28.
28. Grödstein GP, Blumenkrantz MJ, Kopple JD.Nutritional and metabolic response to catabolic stress in chronic uraemia. Am J Clin Nutr1980;33:1411–6.
29.
29. Frisancho AR.1 New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr1981;34:2540–5.
30.
30. Del Canale S, Fiaccadori E, Ronda N, et al. Muscle energy metabolism in uremia. Metabolism1986;35:981–3.
31.
31. Goodship THJ, Mitch WE, Hoerr RA, et al. Adaptation to low protein diets in renal failure: leucine turnover and nitrogen balance. J Am Soc Nephrol1990;1:66–75.
32.
32. Masud T, Young VR, Chapman T, et al. Adaptive response to very low protein diets: the first comparison of ketoacids to essential amino acids. Kidney Int1994;45:1182–92.
33.
33. Tom K, Young VR, Chapman T, et al. Long-term adaptative responses to dietary protein restriction in chronic renal failure. Am J Physiol1995;268:E668–77.
34.
34. May RC, Kelly RA, Mitch WE.Metabolic acidosis stimulates protein degradation in rat muscle by a glucocorticoiddependent mechanism. J Clin Invest1986;77:614–21.
35.
35. Williams B, Hattersley J, Layward E, et al. Metabolic acidosis and skeletal muscle adaptation to low protein diets in chronic uremia. Kidney Int1991;40:779–86.
36.
36. Romiyn JA, Gotfried MH, Hommes MJT, et al. Decreased glucose oxidation during starvation. Metabolism1990;39:525–30.
37.
37. Perna AF, Smogorzewski M, Massry SG.Verapamil reverses PFK-or CRF-induced abnormal fatty acids oxidation in muscle. Kidney Int1988;34:774–8.
38.
38. Perna AF, Smoforzewski M, Massry SG.Effects of Verapamil on the abnormalities in fatty acid oxidation of myocardium. Kidney Int1989;36:453–7.
39.
39. Coleman E: Correlazioni metaboi che tra carboidrati, lipidi and proteine. In: Duncan G, ed. Le malattie del metabolismo. Roma: Societa Editrice Universo, 1974, 113–217.
40.
40. Russel DH, Walker PM, Leiter LA, et al. Metabolic and structural changes in skeletal muscle during hypocaloric dieting. Am J Clin Nutr1984;39:503–13.
41.
41. Barnea N, Drory Y, Iaina A, et al. Exercise tolerance in patients on chronic haemodialysis. Isr J Med Sci1980;16:17–21.
42.
42. Goldeberg AP, Geltman EM, Hagberg JM, et al. Therapeutic benefits of exercise training for haemodialysis patients. Kidney Int1983;24:303–9.
43.
43. Kettner A, Goldberg A, Hagberg J, et al. Cardiovascular and metabolic responses to submaximal exercise in haemodialysis patients. Kidney Int1984;26:66–71.
44.
44. Cline N, Jögestrand T, Lars-Eric L, et al. Factors limiting working capacity in predialytic uraemic patients. Acta Med Scand1987;222:183–90.
45.
45. Combe C, Deforges-Lasseur C, Caix J, et al. Compliance and effects of nutritional treatment on progression and metabolic disorders of chronic renal failure. Nephrol Dial Transplant1993;8:412–8.
46.
46. Knochel JP, Seldin DW.The pathophysiology of uremia. In: Brenner BM, Rector FC Jr, eds. The Kidney, Philadelphia: Saunders, 1976:1448–85.
