On chronic kidney disease and a therapy that may help delay the onset of dialysis.
In 2011, the Health Director-General announced that 4.2 million Malaysians were at risk of chronic kidney disease (CKD). In 2012, there were 28,590 patients receiving dialysis, according to the 20th report of the Malaysian Dialysis And Transplant Registry. Each year, approximately 5,000 new patients need dialysis.
You may be at risk of CKD if you suffer from one or more of the following conditions:
· Diabetes mellitus
You are also at risk if you:
· Are over the age of 60
· Have family history of kidney failure
· Have taken, or are taking painkillers regularly
According to Assoc Prof Dr Lim Soo Kun, consultant nephrologist and physician at University Malaya Medical Centre: “CKD is a condition characterised by a gradual loss of kidney function over time. Our kidneys remove waste like urea, ammonia and toxic substances from the body. When kidneys do not work properly, harmful waste and fluids are not excreted, but are left in the body, leading to a condition known as uraemia. If untreated, it will soon lead to end-stage renal failure that may require dialysis or kidney transplantation. Besides that, it may cause blood pressure to rise, and prevent the body from making enough red blood cells.”
Measuring Kidney Function
Kidney function is best measured by its glomerular filtration rate (GFR), which determines if a person has kidney disease, and, if so, the stage the disease is at. This is calculated based on the result of a blood creatinine test.
CKD is called the silent killer because it presents no symptoms in its earliest, most treatable phase. There are five stages of chronic kidney disease based on GFR. Stage 1 patients will have 90% GFR. A Stage 5 patient will have entered end-stage renal disease (ESRD), having 15% or less GFR, and will need dialysis.
“The most common causes of CKD are diabetes and high blood pressure (hypertension). High blood sugar levels caused by diabetes will damage blood vessels in the kidneys. This damage gradually reduces the function of the kidneys. CKD is also associated with a number of serious complications, including cardiovascular disease, hyperlipidaemia, anaemia and metabolic bone disease.
“Because CKD is irreversible, it is very important that early diagnosis is made so that doctors can help to preserve existing kidney function and delay deterioration. Three recommended tests to detect early kidney disease are blood pressure measurement, blood test for kidney function and urine test for albumin (protein) leaking,” says Lim.
Nephrologists strive to keep their patients from needing dialysis because of the financial burden and complications that can come with end-stage renal disease. In addition, the quality of life of CKD patients is compromised, as patients need to undergo dialysis three times a week for a period of four hours each.
Dietary therapy is one of the approaches in CKD management, along with blood pressure control, blood sugar control, reduction of proteinuria, and the use of drugs with “kidney protection” effects. The renal division at University Malaya Medical Hospital works with the Dietetic Department to ensure patients with CKD are informed about the crucial role diet plays in the management of CKD.
A high-protein diet is the main reason for the accumulation of waste in the body, leading to the deterioration of kidney function and uraemia. Dietician Lau Wai Pooi says that low protein diets reduce the amount of waste build-up, helping to minimise symptoms and the side effects of CKD.
“Patients are put on a low-protein diet if their GFR is less than 60%. Dietitians try to limit protein intake at two to three exchanges of high biological protein a day for CKD patients. One meat exchange equals the size of a traditional box of matches. The role of a dietician is to balance the intake for optimum health, both for patient, as well as for their kidneys,” she says.
Called the building blocks of life, the basic unit of proteins are amino acids. The body uses amino acids to generate cells, hormones and enzymes. Among the 20 types of amino acids in our body, there are nine types that are not self-produced and must be obtained from mainly protein-rich foods.
These nine types of amino acids are known as essential amino acids. When a patient adopts a low-protein diet to slow down the progression of chronic kidney disease, he faces the problem of malnutrition due to a lack of essential amino acids.
Use Of Keto Acids
Apart from a low-protein diet, both Lim and Lau find keto acid therapy effective. There are two potential benefits of keto acid therapy. The first is to reduce urea generation and delay the onset of uraemia (and thus, the need for dialysis). The other benefit is to reduce protein leaking into urine and to offer additional “kidney protection”.
“In view of the risk of malnutrition, we need to be cautious in advising dietary protein restriction in certain patient groups, e.g. the elderly and those who have pre-existing malnutrition or a hypercatabolic state. The nitrogen in the amino acids is a cause of the progression of CKD, so I sometimes advise patients to take amino acids without nitrogen.
“These amino acids or protein without nitrogen are known as keto acids. Keto acids allow an appropriate intake of amino acids without a corresponding nitrogen load. I have found that it helps to maintain nutrition while reducing diet protein,” Lim shares.
Lau concurs: “Keto acids are the nitrogen-free analogues of essential amino acids. Amino acids are the building blocks of all proteins. Treatment with keto acids, together with a low-protein diet, is referred to as keto acid therapy. Keto acids capture the nitrogen within the body and transform themselves into amino acids needed by the body.
“Malnutrition is thus prevented and the workload of the kidneys to excrete nitrogen-containing waste products is reduced. I believe keto acid therapy does good. It is no miracle cure though. I do not press it on my patients. I simply tell them about what I believe about the use of keto acids.
Lioom adds: “Whatever the situation, I stress to patients that keto acids can only work with a low protein diet. In patients with good compliance, I have been able to see very positive outcomes to keto acid therapy.”
> This article is courtesy of Fresenius Kabi.