INFLUENCE OF ESSENTIAL AMINO ACIDS KETOANALOGS AND PROTEIN RESTRICTION TO PHOSPHORIC CALCIUM METABOLISM REGULATORS PRODUCTION - MORPHOGENETIC PROTEINS (FGF-23 AND KLOTHO) IN CKD PATIENTS 3B-4 STAGES

AIM: to evaluate the influence of essential amino acids ketoanalogs (EAAK) and low protein diet (LPD) to production of phosphoric calcium metabolism regulators - morphogenetic proteins FGF-23 and Klotho in patients with chronic kidney disease (CKD) stages 3B-4. PATIENTS AND METHODS: The study included 50 nondiabetic CKD stage 3B-4 patients which were divided into 2 groups depending on the diet type. Group 1 (n=25) got LPD-0.6 grams/kg /day and took EAAK - Ketosteril 1 tab./5 kg/day within 12 observation months; Group 2 (n=25) was comparable to the 1st group by age, sex and GFR reduction degree, also held LPD, but did not take EAAK. FGF-23, alpha - Klotho, phosphorus, total calcium and parathyroid hormone (PTH) serum levels were examined, bioimpedance analysis, echocardiography, abdominal aorta radiography in lateral projection and pulse wave velocity were performed in all patients at the screening time and after 12 months follow. RESULTS: None patient of the Group 1 were recorded nutritional status disorders, while in Group 2 five patients marked nutritive disorders: decrease in muscle mass and body mass index. In addition, CKD patients in Group 1 had lower serum PTH, phosphorus and FGF-23 levels (p<0,05) and higher alpha-Klotho serum levels, than patients in Group 2. Heart and aorta calcification, as well as blood vessels damping function violation were detected significantly more [8% versus 16%, p <0,05 and 8% versus 20%, p <0,05, respectively] in 2nd Group patients than in the 1st. Wherein, there was a significant concentric left ventricular hypertrophy degree increase (16% vs. 32%) in Group 2 patients, that was inversely correlated with GFR (r=-0,540; p<0,01). CONCLUSIONS: EAAK application in CKD stages 3B-4 patients receiving LPD provides not only prevention of nutritional status violations, but also contributes to a more effective correction of hyperphosphatemia, hypocalcemia, decrease hyperproduction of FGF-23 and increase production of alpha-Klotho. Increase of alpha-Klotho production in serum led to reduction in both heart and blood vessels calcification and concentric remodeling of left ventricle myocardium.

α-Klotho, Chronic kidney disease, essential amino acids ketoanalogs, fibroblast growth factor-23 (FGF-23), alpha-Klotho (Klotho), parathyroid hormone (PTH), ectopic calcification

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