开同专家会议上课讲义.ppt

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

2、ventionofthesecomplicationsshouldbetheaimwhilemanagingCKDpatientsinordertoimproveausuallypooroutcome.WhybeneficialeffectsonmetabolicdisorderscanbeexpectedfromSVLPDSVLPDpermitstherestrictionoftheintakeoroftheproductionofnitrogenouswasteproducts,phosphat

3、e,inorganicionsandhydrogenions.SVLPDimprovesNa+K+ATPaseactivityinCRFpatientsLastly,itislikelythatSVLPDiseffectiveincorrectinginflammationassuggestedbyrecentnutritionalinterventionsusingaconventionalLPDorMediterranean-styledietCaloricsupply(kcal/kgbw/da

4、y)30-35%fromcarbohydrates67%fromlipids30%fromproteins3Proteincontent(g/kgbw/day)0.3-0.4(max.0.6)Phosphoruscontent(mg/kgbw/day)5-7Supplementedwith:Calcium(g/day)0.5-1.0VitaminD(IU/day)1,000Iron(mg/day)100mg/kgbw/day10-15DietarymanagementinCKDComposition

5、ofaKetoAcidTherapyKA/AA(Ketosteril®)EffectsofSVLPDoncarbohydratemetabolismdisordersInsulinresistanceinCKDpatientsOccursearlyinthecourseofCRFandispresentinmorethan50%ofCKDpatients.Isfavouredby:-accumulationofproteinwasteproducts-metabolicacidosis-infla

6、mmation-2ndHPTInsulinresistanceinCKDpatientseffectsoncarbohydratemetabolismInsulinresistance:-decreasedglucosestorage-decreasedglucoseoxidation-increasedendogenousglucoseproduction-decreasedmetabolicclearancerateofinsulin-elevatedfastingglucoseandinsul

7、inlevelsInsulinresistanceintypeIIdiabetesandinCRFtypeIIdiabetesCRFglycemia+++insulinlevels++++glucosestorage----glucoseoxidation--EGP++++Invivoexplorationofglucosemetabolism:thetoolsOralglucosetolerancetest:overallglucosemetabolismHyperinsulinemiceug

8、lycemicclamp:insulinsensitivity,MCRofexogenousinsulinConcomitantuseofindirectcalorimetry:oxidativeandnonoxidativepathwayofglucoseIsotopicallylabeledglucose:endogenousglucoseproductionPlasmaglucoseandInsulinafteroralglucoseloadbeforeanda