Research Of The Related Factors Of Nutrition And Mineral Metabolism In Chronic Renal Failure

Objective To measure and discuss the relationship of nutrition, mineral metabolism, inflammation and oxidative stress indicators, observe the indicators influenced by compoundα-keto acids and in order to detect and prevent of the malnutrition and mineral metabolism disorders in chronic renal failure earlier.Methods 15 patients with CKD 4～5,40 patients with hemodialysis,15 patients with peritoneal dialysis, and 12 normal adults were enrolled in the study.40 patients with hemodialysis were divided into experimental group and control group, gave the dietary guidance for patients and common diet were made according their diet habbits, calorie intake was 30～35kcal/kg/d, and gave the compoundα-keto acids 12 slices/d and calcium carbonate 2.25g/d for six months, the MHD control group were given calcium carbonate 4.5g/d for six months without compoundα-keto acids. Interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), insulin like growth factor-1 (IGF-1) and leptin were measured by enzyme linked immunosorbent assay (ELISA).The malondialdehyde(MDA) was measured by colorimetric technique. Anthropometry measurements included body mass index(BMI), triceps skinfold (TSF), middle arm muscle circumference (MAMC), lean body mass(LBM), fat mass(FM). Hemoglobin(Hb), albumin(Alb), pro-albumin(PA), serum creatinine(Scr), blood urea nitrogen(Bun), triglycerides(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), lipoprotein-α(Lp-α), C-reactive protein(CRP), carbon dioxide(CO2), blood calcium(Ca), phosphorus(P) and the intact parathyroid hormone(iPTH) were measured by complete blood analyzer and automatic biochemistry analyzer.Results The levels of IGF-1,Hb,A1b,Ca,HDL-C,CO2 were lower, and IL-6,TNF-α,Leptin,MDA,P,iPTH,CRP,Scr,Bun,TG,TC,LDL-C,Lp-αin experimental group were higher than the normal control group(P<0.05 or P<0.01). There were positively correlations between phosphate and IL-6,TNF-α,Leptin,IGF-1,MDA(P <0.05 or P<0.01), there were negatively correlations between IGF-1 and iPTH(P< 0.01). After the treatment of compoundα-keto acids, the levels of Hb,A1b,Ca,HDL-C,CO2 were increased, P,iPTH and blood lipid were decreased in experimental group(P< 0.05 or P<0.01). Conclusions 1. Chronic renal failure patients generally have different levels of malnutrition and minerals metabolism disorders, oxidatie stress, chronic micro-inflammation and endocrine metabolic disorders were involved; 2. Compound a-keto acids can effectively improve the malnutrition and lipid metabolism of chronic renal failure patients, and phosphate and iPTH levels were significantly decreased, and will not cause hypercalcemia, it provides a safe and effective way for the hyperphosphatemia hardly corrected by calcium;3. The further study of a large, multicenter, randomized clinical experiments is expected to testify the efficacy and safety of long-term treatment.