Amino acid losses and nitrogen balance during slow diurnal hemodialysis in critically ill patients with renal failure.
OBJECTIVE
The effects of slow diurnal hemodialysis (slow HD) on amino acid losses and nitrogen balance were studied.


METHODS
Slow HD was conducted for 10 h during the day at the dialysate flow rate of 30 ml/min. The patients received total parenteral nutrition including 40 g of amino acids (6.08 g of nitrogen). The amino acid concentrations in plasma and dialysate were determined and the daily nitrogen balance was calculated from the urea nitrogen appearance.


METHODS
Six critically ill patients with renal failure were entered into the study.


RESULTS
Slow HD eliminated 48.5 +/- 4.4 mmol (6.2 +/- 0.6 g) of amino acids, representing 16% of the daily amino acid load. The estimated nitrogen balance was -2.3 +/- 1.3 g/day. Amino acid nitrogen lost in the dialysate was 1.0 +/- 0.1 g, contributing 43% of the daily negative nitrogen balance.


CONCLUSIONS
The amount of amino acid losses during slow HD should be taken into consideration when designing nutritional schedules for maintaining positive nitrogen balance in critically ill patients.
Kihara
M
M
Department of Internal Medicine II, Yokohama City University School, Japan.
Ikeda
Y
Y
Fujita
H
H
Miura
M
M
Masumori
S
S
Tamura
K
K
Yabana
M
M
Takagi
N
N
Umemura
S
S
Ishii
M
M
D000368:Aged; D000596:Amino Acids / Q000032:analysis / Q000378:metabolism*; D001806:Blood Urea Nitrogen; D002851:Chromatography, High Pressure Liquid; D003404:Creatinine / Q000097:blood / Q000378:metabolism; D016638:Critical Illness; D015314:Dialysis Solutions / Q000032:analysis; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism*; D010289:Parenteral Nutrition, Total; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000378:metabolism*
D000596:Amino Acids; D015314:Dialysis Solutions; D003404:Creatinine; D009584:Nitrogen