Evaluation of the Progressivity Parameters of Chronic Kidney Disease after Branched-Chain Amino Acid Supplementation in Children

Esthy Poespitaningtyas, Roedi Irawan, Ninik Asmaningsih Soemyarso, Jusak Nugraha


Chronic Kidney Disease (CKD) is not an uncommon issuein children. Chronic kidney disease is the abnormality of
structure or function of the kidney that occurs for more than three months. The presence of a longitudinal decline in
Glomerulus Filtration Rate (GFR), proteinuria, and hypertension Are the characteristics of CKD. One of the recommendations
of nutritional supplementation as the prevention of CKD is by the administration of oral Branched-Chain Amino Acid (BCAA).
To date, there has been no research to analyze the effects of the BCAA on children with stage 2-4CKD. This study aimed to
analyze the effect of BCAA in inhibiting the progressivity of stage 2-4 CKD in children and improving nutritional status.A
study with randomized pre-post test controlled trial design was performed in the Outpatient Clinic of Pediatric Nephrology
in Dr. Soetomo Hospital with stage 2-4CKD. The subjects were divided into two groups, such as the BCAA and placebo, and
were monitored for eight weeks to be evaluated the GFR, albumin, proteinuria, blood pressure, and nutritional status.
Sixteen children with stage 2-4 CKD dominated by 71.4% of male patients were enrolled in this study. The mean age was 12.5
(SD 2.90) years. Approximately 50% (p=0.767) stage 2 chronic kidney, 50% (p=1.000) moderate malnutrition, and 64.28%
(p=1.000) short stature were found, with nephrotic syndrome as the most common underlying cause of CKD (p=0.149). In
BCAA group, decrease of GFR -5.08±7.13 (p=0.055), increase of serum albumin 0.20±0.23 (p=0.062), decrease of delta
systole -11.57±15.08 (p=0.565) and diastole -4.85±16.25 (p=0.708), weight loss -0.07±1.01 (p=0.828), an increase of height
0.14±0.24 (p=0.771), and a decrease in BMI -0.03±0.74 (p=0.389) were reported. It was concluded that branched-chain
amino acid (leucine, isoleucine, and valine) supplementation did not provide a significant effect to inhibit progressivity of
stage 2-4CKD in children and improvement of nutritional status.


Chronic kidney disease, branched-chain amino acid, progressivity of chronic kidney disease, nutritional status

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KDOQI. Clinical practice guideline for nutrition in children with chronic kidney disease. Am J Kidney Dis. 2002; 39(1): S1-S26.

Hogg RJ. National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease in Children and Adolescents: Evaluation, Classification, and Stratification. Pediatrics. 2003; 111: 1416-21

Levey AS. Chronic Kidney Disease Progression. Lancet. 2007; 379: 165-80.

Hammarqvist F, Wernerman J, Ali R, von der Decken A, and Vinnars E. Addition of glutamine to total parenteral nutrition after elective abdominal surgery spares free glutamine in muscle, counteracts the fall in muscle protein synthesis, and improves nitrogen balance. Annals of Surgery. 1989; 209(4): 455-61.

Nair KS and Short KR. Hormonal and signaling role of branched-chain amino acids. J of Nutr. 2005; 135(6): 1547S-52S.

Hiroshige K, Sonta T, Suda T, Kanegae K, and Ohtani A. Oral supplementation of branched-chain amino acid improves nutritional status in elderly patients on chronic haemodialysis. Nephrol Dial Transpl. 2001; 16(9): 1856-62.

Schuldt S, Carter P, and Welbourne T. Glutamate transport asymmetry and metabolism in the functioning kidney. Am J of Physiol Endocr and Metab. 1999; 277(3): E439-46.

Khan IA, Nasiruddin M, Haque SF and Khan RA. A Randomized clinical trial to evaluate the efficacy and safety of a-keto amino acids in stage 3 and 4 of Chronic Kidney Disease. Asian J Pharm Clin Res. 2014; 7(3): 21-4.

Soares CMB, Diniz JSS, Lima EM, Silva JMP, Oliveira GR and Canhestro MR, et al. Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program. Pediatr Nephrol. 2008; 23: 2039-46.

Ardissino G, Daccò V and Testa S, et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003; 111: e382–7.

Warady BA and Chadha V. Chronic kidney disease in children: the global perspective. Pediatr Nephrol. 2007; 22: 1999-2009.

Amira P, Bogdanovic R, Paripovic D, Paripovic A, Kocev N, Golubovic and Milosevic B. Epidemiology of chronic kidney disease in children in Serbia. Nephrol Dial Transplant. 2011; 27: 1978-84.

Stel VS, Kramer A and Zoccali C, et al. The 2007 ERA-EDTA registry annual report-a precis. NDT plus. 2009; 2: 514-52.

Gheissari A, Hemmatzadeh S, Merrikhi A, Tehrani SF and Madihi Y. Chronic Kidney disease in children: a report from a tertiary care centre over 11 years. J Nephropathol. 2012; 1: 177-82.

Wong H, Mylrea K, Feber J, Drukker A and Filler G. Prevalence of complication in children with chronic kidney disease according to KDOQI. Kidney Int. 2006; 70: 585-90.

Wilson LM. Sindrom Uremik. In: Price SA, Wilson LM (eds). Clinical Concept of Disease Processes, 4th ed. EGC, Jakarta. 1995; 848-61.

Cano NJ, Fouque D and Leverve XM. Application of branched chain amino acids in human pathological states: renal failure. J Nutr. 2006; 136: 299S–307S.

Grahammer F, Wanner N and Huber TB. mTOR controls kidney epithelia in health and disease. Nephrol Dial Transplant. 2014; 29: 109-18.

Huber TB, Walz G and Kuehn EW. mTOR and rapamycin in the kid¬ney: signaling and therapeutic implications beyond immunosup¬pression. Kidney Int. 2011; 79: 502-11.

Hay N and Sonenberg N. Upstream and downstream of mTOR. Genes and Development. 2004; 18(16): 1926–45.

Ijichi C, Matsumura T, Tsuji T and Eto Y. Branched-chain amino acids promote albumin synthesis in rat primary hepatocytes through the mTOR signal transduction system. Biochem Bioph Res Co. 2003; 303(1): 59–64.

Bellizzi V, Di lorio BR, and De Nicola L, et al. Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kid Int. 2007; 71: 245-51.

McAllan L, Cotter PD, Roche HM, Korpela R and Nilaweera KN. Impact of leucine on energy balance. J Physiol Biochem. 2013; 69: 155–63

Chazot C. Why are chronic kidney disease patients anorexic and what can be done about it?. Seminars in Nephrol. 2008; 29(1): 15-23.

Walser M, Coulter W, Dighe S and Crantz FR. The effect of ketoanalogues of essential amino acids in severe chronic uremia. J Clin Invest. 1973; 52: 678-90.

Mitch WE, Price SR, May RC, Jurkovitz C and England BK. Metabolic consequences of uremia: extending the concept of adaptive responses to protein metabolism. Am J Kidney Dis. 1994; 23: 224-8.

Meng WC, Leung KL, Ho RL, Leung TW and Lau WY. Prospective randomized control study on the effect of branched-chain amino acids in patients with liver resection for hepatocellular carcinoma. Aust N Z J Surg. 2014; 69: 811–5.

DOI: http://dx.doi.org/10.24293/ijcpml.v26i2.1467


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