title: Protein intake during hemodialysis maintains a positive whole body protein balance in chronic hemodialysis patients.
abstract: Protein energy malnutrition is present in 18 to 56% of hemodialysis patients. Because hemodialysis has been regarded as a catabolic event, we studied whether consumption of a protein- and energy-enriched meal improves the whole body protein balance during dialysis in chronic hemodialysis (CHD) patients. Patients were studied on a single day between dialysis (HD- protocol) in the morning while fasting and in the afternoon while consuming six small test meals. Patients were also studied during two separate dialysis sessions (HD+ protocol). Patients were fasted during one and consumed the meals during the other. Whole body protein metabolism was studied by primed constant infusion of l-[1-(13)C]valine. During HD-, feeding changed the negative whole body protein balance observed during fasting to a positive protein balance. Dialysis deepened the negative balance during fasting, whereas feeding during dialysis induced a positive balance comparable to the HD- protocol while feeding. Plasma valine concentrations during the studies were correlated with whole body protein synthesis and inversely correlated with whole body protein breakdown. We conclude that the consumption of a protein- and energy-enriched meal by CHD patients while dialyzing can strongly improve whole body protein balance, probably because of the increased amino acid concentrations in blood.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University Hospital Groningen and Groningen University Institute of Drug Exploration, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
authors.forename: Jorden M
authors.initials: JM
authors.lastname: Veeneman
authors.forename: Hermi A
authors.initials: HA
authors.lastname: Kingma
authors.forename: Theo S
authors.initials: TS
authors.lastname: Boer
authors.forename: Frans
authors.initials: F
authors.lastname: Stellaard
authors.forename: Paul E
authors.initials: PE
authors.lastname: De Jong
authors.forename: Dirk-Jan
authors.initials: DJ
authors.lastname: Reijngoud
authors.forename: Roel M
authors.initials: RM
authors.lastname: Huisman
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000378:metabolism; D004044:Dietary Proteins / Q000008:administration & dosage*; D005215:Fasting / Q000378:metabolism; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011506:Proteins / Q000378:metabolism*; D006435:Renal Dialysis; D013997:Time Factors; D014633:Valine / Q000008:administration & dosage / Q000378:metabolism
chemical_list: D000596:Amino Acids; D004044:Dietary Proteins; D011506:Proteins; D014633:Valine