Essential keto amino acids (KA) and recombinant human erythropoietin (rHuEPO) may each separately modulate the metabolic status of patients with chronic renal insufficiency. Our study was designed to monitor the simultaneous metabolic effect of these drugs in a long-term metabolic follow-up. In a prospective randomized study, we evaluated, for a period of 12 months, a total of 38 patients (20M/18F) aged 32–68 years with a CKr of 0.2–0.6 mL/s. All patients were on rHuEPO (Hb < 115 g/L a Htk < 32) and a low-protein diet (0.6 g protein/kg/day and 135 kJ/kg/day). The diet of 20 patients (Group I) was supplemented with KA – 100 mg/kg/day – while 18 patients (Group II) had no supplementation. During the study period, the glomerular filtration rate decreased slightly (CKr and C in), and the difference was significant (Group I vs Group II, p < 0.01). The urea serum levels also declined (p < 0.01); there was a significant difference between both groups (p < 0.025). In Group I, there was a significant rise in the levels of leucine (p < 0.01), isoleucine (p< 0.01), valine (p < 0.02) and albumin (p < 0.01) associated with a decrease in Whitehead’s quotient (p < 0.01) and proteinuria (p < 0.01). Analysis of the lipid spectrum revealed a mild yet significant decrease in total cholesterol and LDL-cholesterol (p < 0.02). In Group I, significant changes were noted in TG levels (from 4.2 ± 0.8 to values a low as 2.2 ± 0.6 mmol/L; p < 0.01) whereas HDL-cholesterol levels increased (from 0.9 ± 0.1 to values as high as 1.25 ± 0.1 mmol/L, p < 0.01. The finding of decreased urinary NO/24 hrs (p < 0.01) and free radicals (p < 0.01) was also remarkable. It is evident from our findings that concomitant administration of KA and rHuEPO resulted in an accentuation of their effects on the amino acid, protein, and lipid metabolism. Co-administration of KA and rHuEPO thus constitutes an effective alternative to conservative management of chronic renal insufficiency (CRI), delaying progression of renal insufficiency and correction of metabolic parameters including proteinuria.

        Key words: keto amino acids, recombinant erythropoietin, branched-chain amino acids, proteins, lipids.