Acute effect of amino acid peritoneal dialysis solution on vascular function.
BACKGROUND
Oral ingestion of proteins or amino acids is associated with endothelial dysfunction. The effect of commercial amino acid peritoneal dialysis solutions on vascular function is unknown.


OBJECTIVE
We compared the acute effect of intraperitoneal amino acid administration with that of intraperitoneal glucose administration on vascular function in peritoneal dialysis patients.


METHODS
In an open-label randomized, controlled, crossover and observer-blinded trial, we examined the acute effect of an intraperitoneal application of 2 L commercial 1.1% amino acid solution compared with that of a 2.27% glucose solution in 13 peritoneal dialysis patients. The primary endpoint was the change in forearm reactive hyperemia 6 h after instillation of either dialysis solution.


RESULTS
After 6 h of dwell time, reactive hyperemia was substantially impaired after administration of the amino acid solution compared with the glucose solution (median difference: 202%; 95% CI: 57%, 368%; P = 0.007). In a comparison of differences between values at 6 h and those before treatment, reactive hyperemia significantly decreased during the dwell with the amino acid dialysis solution compared with that with the glucose dialysis solution (median difference: 242%; 95% CI: 53%, -457%; P = 0.013). In an analysis of smoking and nonsmoking patients separately, the difference in forearm blood flow between the 2 treatments was still statistically significant.


CONCLUSIONS
One 6-h dwell with a commercial amino acid dialysis solution acutely impairs forearm reactive hyperemia in smoking and nonsmoking peritoneal dialysis patients. Because endothelial dysfunction is associated with increased morbidity and mortality, the long-term use of these solutions may increase the risk of cardiovascular disease.
Division of Nephrology and Dialysis, Department of Medicine III, University of Vienna, Austria. andreas.vychytil@univie.ac.at
Andreas
A
Vychytil
Manuela
M
Födinger
Johannes
J
Pleiner
Marcus
M
Müllner
Peter
P
Konner
Sonja
S
Skoupy
Claudia
C
Röhrer
Michael
M
Wolzt
Gere
G
Sunder-Plassmann
D000328:Adult; D000596:Amino Acids / Q000008:administration & dosage / Q000009:adverse effects*; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure; D018592:Cross-Over Studies; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D005542:Forearm / Q000098:blood supply; D005947:Glucose / Q000008:administration & dosage; D006710:Homocysteine / Q000097:blood; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010991:Plethysmography; D012996:Solutions; D014652:Vascular Diseases / Q000139:chemically induced*
D000596:Amino Acids; D012996:Solutions; D006710:Homocysteine; D005996:Nitroglycerin; D005947:Glucose