title: Effects of amino acid dialysis compared to dextrose dialysis in children on continuous cycling peritoneal dialysis.
abstract: OBJECTIVE
  To compare the biochemical and nutritional effects of amino acid dialysis with dextrose dialysis in children receiving continuous cycling peritoneal dialysis (CCPD).
  
  
  METHODS
  A prospective randomized cross-over study.
  
  
  METHODS
  Nonhospitalized patients.
  
  
  METHODS
  Seven children aged 1.8 to 16.0 years (mean 8.1 years) with end-stage renal disease who were receiving CCPD.
  
  
  METHODS
  Each patient received nighttime automated CCPD of dextrose, plus a single daytime dwell of either amino acid dialysate or dextrose dialysate. After 3 months, subjects crossed over to the alternative regimen for a subsequent 3 months.
  
  
  METHODS
  Creatinine clearance, ultrafiltration, urea, creatinine, electrolytes, total protein, albumin, fasting plasma amino acids, anthropometrics, total body nitrogen.
  
  
  RESULTS
  Amino acid dialysis was comparable to dextrose dialysis for creatinine clearance and ultrafiltration. Plasma urea concentrations were higher during amino acid dialysis. No clinical side effects or worsening of metabolic acidosis was observed. Caloric intake increased and protein intake improved. Appetite and total body nitrogen increased in at least half the children during amino acid dialysis. Total plasma protein and albumin concentrations did not change significantly. Fasting plasma concentrations of amino acids after 3 months of amino acid dialysis were comparable to baseline values. For several amino acids, the dose-response curve was blunted after a single amino acid exchange following 3 months of amino acid dialysis, which may, in part, be due to the induction of hepatic enzyme synthesis.
  
  
  CONCLUSIONS
  Amino acid dialysis is an efficient form of peritoneal dialysis that should be considered for children with poor nutritional status for whom enteral nutrition supplementation has been unsuccessful. Further study is needed to determine the optimal amount of amino acids to deliver, the best time to administer the amino acid dialysis fluid, and the benefits of adding dextrose to the amino acid solution.
authors.affiliation: Division of Pediatric Nephrology, The Hospital for sick Children and the University of Toronto, Ontario, Canada.
authors.forename: I U
authors.initials: IU
authors.lastname: Qamar
authors.forename: D
authors.initials: D
authors.lastname: Secker
authors.forename: L
authors.initials: L
authors.lastname: Levin
authors.forename: J A
authors.initials: JA
authors.lastname: Balfe
authors.forename: S
authors.initials: S
authors.lastname: Zlotkin
authors.forename: J W
authors.initials: JW
authors.lastname: Balfe
mesh_terms: D000293:Adolescent; D000596:Amino Acids / Q000097:blood; D000886:Anthropometry; D001066:Appetite; D001798:Blood Proteins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000378:metabolism; D018592:Cross-Over Studies; D015314:Dialysis Solutions; D002149:Energy Intake; D005260:Female; D005947:Glucose; D006801:Humans; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy; D008297:Male; D009584:Nitrogen / Q000032:analysis; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D014508:Urea / Q000378:metabolism
chemical_list: D000596:Amino Acids; D001798:Blood Proteins; D015314:Dialysis Solutions; D014508:Urea; D003404:Creatinine; D005947:Glucose; D009584:Nitrogen