Unwanted Side Effects of Nutritional Therapy for Patients with Chronic Renal Failure

  • S. Giovannetti
Part of the Topics in Renal Medicine book series (TIRM, volume 7)


It is widely believed that protein malnutrition is a serious risk, if not an inevitable consequence, of low-protein diets (LPDs). This is, in fact, one of the main obstacles to its widespread use. This conviction is particularly deep-rooted in countries whose eating habits involve high nitrogen ingestion. In countries where meat and protein (PR) of high biological value (HBV) in general were traditionally—or even still are—eaten only rarely, this prejudice is not a problem.


Chronic Renal Failure Nitrogen Balance Nutritional Therapy Unwanted Side Effect Total Iron Binding Capacity 
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  1. 1.
    Young VR: (1986) Some metabolic and nutritional considerations on dietary protein restrictions. In: Mitch WE, The Progressive Nature of Renal Disease. New York: Churchill Livingstone, pp 263–283.Google Scholar
  2. 2.
    Kopple JD, Coburn JW: (1973) Metabolic studies of low protein diets in uremia. I. Nitrogen and potassium. Medicine 52:583–595.PubMedCrossRefGoogle Scholar
  3. 3.
    Giovannetti S, Maggiore Q: (1964) A low-nitrogen diet with protein of high biological value for severe chronic uremia. Lancet i: 1000–1003.CrossRefGoogle Scholar
  4. 4.
    Carmena R, Shapiro FL: (1972) Dietary management of chronic renal failure. Geriatrics 17: 95–102.Google Scholar
  5. 5.
    Motil KJ, Mattheus DE, Bier DM, Burke JF, Munro HN, Young VR: (1981) Whole-body leucine and liysine metabolism: Response to dietary protein intake in young man. Am J Physiol E240:712–721.Google Scholar
  6. 6.
    Rand WM, Scrimshaw NS, Young VR: (1981) Conventional (long-term) nitrogen balance studies for protein quality evaluation in adults: Rationale and limitations. In: Bodwell TTTT, Adkins, Hopkins (eds): Protein Quality in Humans. Westport: AVI Publishing, pp 61–97.Google Scholar
  7. 7.
    Hou JCS, Zhou JN, Zhu HW, Wu JZ, Wu JC, Zhang MW: (1986) Dynamic aspects of whole-body nitrogen metabolism in uremic patients on dietary therapy. Nephron 44:288–294.PubMedCrossRefGoogle Scholar
  8. 8.
    Guarnieri G, Taigo G, Situlin R, Crapesi L, Del Bianco MA, Zanettovich A, Faccini L, Lucchesi A, Oldrizzi L, Rugiu C, Maschio G: (1986) Nutritional assessment in patients with early renal insufficiency on long-term low-protein diet. Contr to Nephrol 53:40–50.Google Scholar
  9. 9.
    Bianchi R, Mariani G, Pilo A, Toni MG: (1975) Effects of long-term low-protein diet on albumin metabolism in chronic uremia. Nephron 15:409–423.PubMedCrossRefGoogle Scholar
  10. 10.
    Landau RL, Kappas A: (1960) Anabolic hormones and hyperparathyroidism. Metabolism 9:1093–1106.Google Scholar
  11. 11.
    Hodkinson A: (1963) Biochemical aspects of primary hyperparathyroidism: An analysis of 50 cases. Clin Sci 25:231–242.Google Scholar
  12. 12.
    Salter JM, Ezrin C, Laidlaw JC, Gornal AG: (1960) Metabolic effects of glucugon in human subjects. Metabolism 9:753–768.PubMedGoogle Scholar
  13. 13.
    Müller WA, Faloona GR, Hungar RH: (1973) Hyperglucagonemia in diabetic ketoacidosis; its prevalence and significance. Am J Med 54:52–57.PubMedCrossRefGoogle Scholar
  14. 14.
    Giovannetti S, Bigalli A, Delia Santa M: (1957) Gli effetti dell’acidosi sperimentale sul meta-bolismo proteico. Minerva Medica 48:4206–4209.PubMedGoogle Scholar
  15. 15.
    May RC, Mitch WE: (1986) Alkali therapy suppresses the muscle proteolysis stimulated by chronic renal failure in rats (abstr). Kidney Int 29:323.Google Scholar
  16. 16.
    Hörl WH, Stepinski J. Schaefer RM, Wanner C, Heidland A: (1983) Role of proteases in hypercatabolic patients with renal failure. Kidney Int 24(Suppl 16):537–542.Google Scholar
  17. 17.
    Cernacek P, Sputsova V, Dzurik R: (1982) Inhibitors of protein synthesis in uremic serum and urine: Partial purification and relationship to amino acid transport. Biochem Med 27:305–316.PubMedCrossRefGoogle Scholar
  18. 18.
    Monasterio G, Giovannetti S, Maggiore Q: (1965) Le traitement diététique de l’urémie chronique. Actualités Nephrologique de L’Hôpital Necker. Editions Médicales. Paris: Flammarion, pp 31–42.Google Scholar
  19. 19.
    Giovannetti S, Barsotti G, Morelli E, Ciardella F, Mariani G, Molea N, Panicucci F, Rossi B: (1980) Insufficienza renale cronica. Dieta ipoproteica supplementata con aminoacidi essenziali e chetoanaloghi. Minerva Medica 71:2415–2430.PubMedGoogle Scholar
  20. 20.
    Giordano C: (1963) Use of exogenous and endogenous urea for protein synthesis in normal and uremic subjects. J Lab Clin Med 62:231–246.PubMedGoogle Scholar
  21. 21.
    Schloerb PR: (1966) Essential L-amino acid administration in uremia. Am J Med Sci 252:650–659.PubMedCrossRefGoogle Scholar
  22. 22.
    Norée LO, Bergström J: (1975) Treatment of chronic uremic patients with protein-poor diet and oral supply of essential amino acids. Clin Nephrol 3:195–203.PubMedGoogle Scholar
  23. 23.
    Attman PO, Bucht H, Isaksson B, Uddehom G: (1979) Nitrogen balance studies with amino acid supplemented low-protein diet in uremia. Am J Cli Nutr 32:2033–2039.Google Scholar
  24. 24.
    Walser M, Coulter AW, Dighe S, Crautz FR: (1973) The effect of keto-analogues of essential amino acids in severe chronic uremia. J Clin Invest 52:678–690.PubMedCrossRefGoogle Scholar
  25. 25.
    Walser M: (1975) Ketoacids in the treatment of uremia. Clin Nephrol 3:180–186.PubMedGoogle Scholar
  26. 26.
    Mitch WE, Abras E, Walser M: (1982) Long-term effects of a new ketoacid-amino acid supplement in patients with chronic renal failure. Kidney Int 22:48–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Mariani G, Barsotti G, Ciardella F, Molea N, Morelli E, Mazzuca N, Niosi F, Buonaguidi F, Fusani L, Panicucci F, Giovannetti S, Bianchi R: (1984) Albumin metabolism and nutritional status of uremic patients on a long-term very low-protein diet supplemented with essential amino acids and ketoanalogues. J Nucl Med and Allied Sci 28:237–244.Google Scholar
  28. 28.
    Wallia R, Gremberg A, Piraino B, Mitro R, Puschett JB: (1986) Serum electrolyte patterns in end-stage renal disease. Am J Kidney Dise 8:98–104.Google Scholar
  29. 29.
    Wright FS, Strieder M, Fowler NB, Giebish G: (1971) Potassium excretion by distal tubule after potassium adaptation. Am J Physiol 221:437–448.PubMedGoogle Scholar
  30. 30.
    Shon DA, Silva P, Hayslett JP: (1974) Mechanism of potassium excretion in renal insufficiency. Am J Physiol 227:1323–1330.Google Scholar
  31. 31.
    Schultz RG, Taggart DD, Shapiro M, Pennell JP, Caglar S, Brieker NS: (1971) On the adaptation of potassium excretion associated with nephron reduction in the dog. J Clin Invest 50:1061–1068.CrossRefGoogle Scholar
  32. 32.
    Hayes CP, Mcleod ME, Robinson RR: (1967) An extrarenal mechanism for the maintenance of potassium balance in severe chronic renal failure. Trans Assoc Am Phys 80:207–216.PubMedGoogle Scholar
  33. 33.
    Wilson DR, Ing TS, Metcolfe-Gibson A, Wrong OM: (1968) The chemical composition of feces in uremia as revealed by “in vivo” dialysis. Clin Sci 35:197–209.PubMedGoogle Scholar
  34. 34.
    Sandle HG, Gaiger E, Tabster S, Goodship TMJ: (1986) Enhanced rectal potassium secretion in chronic renal insufficiency: Evidence for large intestinal potassium adaptation in man. Clin Sci 71:391–401.Google Scholar
  35. 35.
    Maroni BJ, Steinman TI, Mitch WE: (1985) A method for estimating nitrogen intake in patients with chronic renal failure. Kidney Int 27:58–65.PubMedCrossRefGoogle Scholar

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© Kluwer Academic Publishers, Boston 1989

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  • S. Giovannetti

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