Nutritional aspects of plasma protein metabolic studies: Long-term treatment of chronic uraemia by a very-low-protein diet supplemented with essential amino acids and keto analogues

  • G. Mariani
  • G. Barsotti
  • S. Giovannetti
  • R. Bianchi


About 20 years ago the experimental studies by Giordano1 and by Giovannetti and Maggiore2 introduced the use of especially designed low-protein diets for the long-term conservative treatment of chronic uraemic patients3–5. These diets provide the necessary amount of essential amino acids as proteins of high biological value2, the energy needs being supplied essentially by carbohydrates and lipids (see review in reference 6). This restricted protein intake was aimed at reducing as much as possible the toxic signs of uraemia, both by decreasing the retention of metabolic waste products from exogenous sources and by promoting the incorporation of urea nitrogen into non-essential amino acids7–9. However, the main limitation to the long-term efficacy of such diets is the fact that they do not provide any means of correcting the water and electrolyte disturbances of end-stage uraemia.


Essential Amino Acid Residual Renal Function Uraemic Patient Double Tracer Fractional Catabolic Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Giordano, C. (1963). Use of exogenous and endogenous urea for protein synthesis in normal and uremic subjects. J. Lab. Clin. Med, 62, 231.PubMedGoogle Scholar
  2. 2.
    Giovannetti, S. and Maggiore, Q. (1964). A low nitrogen diet with proteins of high biological value for severe chronic uremia.Lancet, i, 1000.CrossRefGoogle Scholar
  3. 3.
    Berlyne, G. M., Shaw, A. B. and Nilwarangkur, S. (1965). Dietary treatment of chronic renal failure. Experiences with a modified Giovannetti diet. Nephron, 2, 129.PubMedCrossRefGoogle Scholar
  4. 4.
    Boström, H., Edgrem, B. and Engelke, B. (1967). Experiences with the Giovannetti diet in chronic uremia. Scand. J. Urol Nephrol, 1, 171.CrossRefGoogle Scholar
  5. 5.
    Wright, P. L., Brereton, P. J. and Snell, D. E. M. (1970). Effectiveness of modified Giovannetti diet compared to mixed low-protein diet.Metabolism, 19, 201.Google Scholar
  6. 6.
    Kopple, J. D. and Swendseid, M. E. (1977). Amino acid and keto acid diets in renal failure. Nephron, 18, 1.PubMedCrossRefGoogle Scholar
  7. 7.
    Rose, W. C., Smith, L. C., Womach, U.,et al. (1949). The utilization of the nitrogen of ammonium salts, urea and certain other compounds in the synthesis of non-essential amino acids in vivo. J. Biol. Chem, 181, 307.PubMedGoogle Scholar
  8. 8.
    Richards, P., Metcalfe-Gibson, A., Ward, E. E., et al (1967). Utilization of ammonia nitrogen for protein synthesis in man, and the effect of protein restriction and uremia. Lancet,ii, 845.CrossRefGoogle Scholar
  9. 9.
    Giordano, C., de Pascale, C., Balestrieri, C., et al. (1968). Incorporation of urea 15N in amino acids of patients with chronic renal failure on low nitrogen diet. Am. J. Clin. Nutr., 21, 395.Google Scholar
  10. 10.
    Friedman, E. A. (1976). Sorbents in the management of uremia. Am. J. Med, 60, 614.PubMedCrossRefGoogle Scholar
  11. 11.
    Schloerb, P. R. (1966). Essential 1-amino administration in uremia. Am. J. Med. Sci, 252, 650.PubMedCrossRefGoogle Scholar
  12. 12.
    Bergstrom, J., Fiirst, P., Josephson, B., et al. (1972). Factors affecting the nitrogen balance in chronic uremic patients receiving essential amino acids intravenously or by mouth. Nutr. Metab, 14, Suppl. 162.Google Scholar
  13. 13.
    Kopple, J. D. and Swendseid, M. E. (1974). Nitrogen balance and plasma amino acid levels in uremic patients fed an essential amino acid diet. Am. J. Clin. Nutr, 27, 806.PubMedGoogle Scholar
  14. 14.
    Arbitol, C. and Holliday, M. H. (1974). Nitrogen-sparing effect of essential amino acids in uremia. Kidney Int., 6,15A.Google Scholar
  15. 15.
    Richards, P., Brown, C. L., Houghton, B. J., et al. (1971). Synthesis of phenylalanine and valine by healthy and uremic men. Lancet, ii, 128.CrossRefGoogle Scholar
  16. 16.
    Walser, M., Coulter, A. W., Dighe, S. V., et al (1973). The effects of keto analogues of essential amino acids in severe chronic uremia. J. Clin. Invest, 52, 673.Google Scholar
  17. 17.
    Close, J. H. (1974). The use of amino acid precursors in nitrogen-accumulation diseases. New Engl. J. Med, 290, 663.PubMedCrossRefGoogle Scholar
  18. 18.
    Walser, M. (1975). Ketoacids in the treatment of uremia. Clin. Nephrol, 3, 180.PubMedGoogle Scholar
  19. 19.
    Mitch, W. E. and Walser, -M. (1977). Nitrogen balance in uremic subjects receiving the hydroxy-analogue of methionine and branched-chain ketoacids as substitutes for the respective amino acids. Clin. Nephrol, 8, 341.PubMedGoogle Scholar
  20. 20.
    Mitch, W. E. and Walser, M. (1977). Utilization of calcium L-phenyllactate as a substitute for phenylalanine by uremic subjects. Metabolism, 26,1041.PubMedCrossRefGoogle Scholar
  21. 21.
    Walser, M. (1978). Keto acid therapy in chronic renal failure. Nephron, 21, 57.PubMedCrossRefGoogle Scholar
  22. 22.
    Donato, L., Vitek,F., Bianchi, R. and Federighi, G. (1967), A double tracer method for metabolic studies with iodinated proteins or polypeptides in presence of a relatively slow excretion of iodide. J. Nucl. Biol Med, 11, 1.Google Scholar
  23. 23.
    Bianchi, R., Mariani, G., Pilo, A., Toni, M. G. and Donato, L. (1973). Short- term determination of plasma protein turnover by a two-tracer technique using plasma only or plasma and urine data. In Protein Turnover(C. E. W. Wolstenholm and M. O’Connor, Eds.), Ciba Foundation Symposium 9 (new series), Associated Scientific Publishers, Amsterdam, p. 47.Google Scholar
  24. 24.
    Pearson, J. D., Veall, N. and Vetter, H. (1956). A practicable method for plasma albumin turnover studies. Strahlentherapie, 38, 290.Google Scholar
  25. 25.
    Mariani, G., Bonaguidi, F. and Bianchi, R. (1978). Turnover studies with radioiodinated albumin in uremic patients. Acta Med. Scand, 204, 129.PubMedCrossRefGoogle Scholar
  26. 26.
    Bianchi, R., Mariani, G., Pilo, A. and Toni, M. G. (1975). Effects of long- term low protein diet on albumin metabolism in chronic uremia. Nephron, 15, 409.PubMedCrossRefGoogle Scholar
  27. 27.
    Mariani, G., Bianchi, R., Pilo, A., Palla, R., Toni, M. G. and Fusani, L. (1974). Albumin catabolism measurement by a double tracer technique in uraemic patients during a single dialytic treatment. Eur. J. Clin. Invest, 4, 435.PubMedGoogle Scholar
  28. 28.
    Bianchi, R., Mariani, G., Toni, M. G. and Carmassi, F. (1978). The meta-bolism of human serum albumin in renal failure on conservative and dialysis therapy. Am. J. Clin. Nutr, 31, 1615.PubMedGoogle Scholar

Copyright information

© The Contributors 1984

Authors and Affiliations

  • G. Mariani
  • G. Barsotti
  • S. Giovannetti
  • R. Bianchi

There are no affiliations available

Personalised recommendations