开同专家会议.ppt

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1、KetoacidtherapyandCKDmetaboliccomplications3rdInternationalKetoanaloguesymposiumSeoul,March30-31,2007M.AparicioM.DIntroductionCRFresultsinnumerousmetabolicdisorderswhichaccountforseverecomplicationsresponsibleformajormorbidityandmortalitycondition.Preventionofthesecomplicationsshouldbetheaimwhilem

2、anagingCKDpatientsinordertoimproveausuallypooroutcome.PhysiopathologyofmetabolicdisordersinCRF°Accumulationofwasteproductsusuallyexcretedbythekidneys:-nitrogenouswasteproducts,H+ions,phosphate….°Iontransportabnormalities°Decreasedhormoneproduction:-EPO,calcitriol°Decreasedhormoneclearance:-insulin

3、,glucagon,leptin°InflammationWhybeneficialeffectsonmetabolicdisorderscanbeexpectedfromSVLPDSVLPDpermitstherestrictionoftheintakeoroftheproductionofnitrogenouswasteproducts,phosphate,inorganicionsandhydrogenions.SVLPDimprovesNa+K+ATPaseactivityinCRFpatientsLastly,itislikelythatSVLPDiseffectiveincor

4、rectinginflammationassuggestedbyrecentnutritionalinterventionsusingaconventionalLPDorMediterranean-styledietCaloricsupply(kcal/kgbw/day)30-35%fromcarbohydrates67%fromlipids30%fromproteins3Proteincontent(g/kgbw/day)0.3-0.4(max.0.6)Phosphoruscontent(mg/kgbw/day)5-7Supplementedwith:Calcium(g/day)0.5-

5、1.0VitaminD(IU/day)1,000Iron(mg/day)100mg/kgbw/day10-15DietarymanagementinCKDCompositionofaKetoAcidTherapyKA/AA(Ketosteril®)EffectsofSVLPDoncarbohydratemetabolismdisordersInsulinresistanceinCKDpatientsOccursearlyinthecourseofCRFandispresentinmorethan50%ofCKDpatients.Isfavouredby:-accumulationofpro

6、teinwasteproducts-metabolicacidosis-inflammation-2ndHPTInsulinresistanceinCKDpatientseffectsoncarbohydratemetabolismInsulinresistance:-decreasedglucosestorage-decreasedglucoseoxidation-increasedendogenousglucoseproduction-decreasedmetabolicclearancerateofinsulin-elevatedfastingglucoseandinsulinlev

7、elsInsulinresistanceintypeIIdiabetesandinCRFtypeIIdiabetesCRFglycemia+++insulinlevels++++glucosestorage----glucoseoxidation--EGP++++Invivoexplorationofglucosemetabolism:thetoolsOralglucosetolerancetest:overallgl