MARTIN G. COGAN, M.D.; JOHN A. SARGENT, Ph.D.; SUSAN G. YARBROUGH, M.S., R.D.; FLAVIO VINCENTI, M.D.; WILLIAM J. AMEND Jr., M.D.
To assess whether increasing dietary protein and calorie intake can ameliorate the negative nitrogen balance induced by 70 to 120 mg/d prednisone, we studied nitrogen intake and net urea generation rate in patients undergoing hemodialysis for 10 to 14 days after renal transplantation. Seven patients receiving prednisone with moderately restricted protein (0.73±0.03 g/kg of body weight per day) and calorie (20±4 kcal/kg of body weight per day) intake had high urea nitrogen generation rates (199±18 mg/kg • d) and protein catabolic rates (1.45±0.12 g/kg • d) and were in marked negative protein balance (-0.72±0.12 g/kg ± d). An increase in protein (1.30±0.06 g/kg • d) and calorie (33±3 kcal/kg • d) consumption in another eight prednisone-treated patients resulted in protein balance (-0.02±0.12 g/kg • d) without further increasing urea generation (174±9 mg/kg • d). Six control patients undergoing hemodialysis after surgery who were not receiving prednisone had lower urea generation rates (109±15 mg/kg • d) and were in nitrogen balance. Nitrogen wasting is therefore not an inevitable consequence of high-dose glucocorticoid therapy and can be effectively prevented by simple nutritional modification without increasing hemodialytic requirements.
MARTIN G. COGAN, JOHN A. SARGENT, SUSAN G. YARBROUGH, FLAVIO VINCENTI, WILLIAM J. AMEND. Prevention of Prednisone-lnduced Negative Nitrogen Balance: Effect of Dietary Modification on Urea Generation Rate in Patients on Hemodialysis Receiving High-Dose Glucocorticoids. Ann Intern Med. 1981;95:158–161. doi: 10.7326/0003-4819-95-2-158
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Published: Ann Intern Med. 1981;95(2):158-161.
Nephrology, Renal Replacement Therapy.
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