Intradialytic amino acids supplementation in hemodialysis patients with malnutrition: results of a multicenter cohort study.
OBJECTIVE
Prospective evaluation of the effect of 6-month-long intradialytic amino acids (AA) supplementation on selected nutritional variables in malnourished hemodialysis (HD) patients.


METHODS
Multicenter, prospective, (nonrandomized, noncontrolled) observational study.


METHODS
Thirty-one HD units affiliated with academic centers and tertiary-care hospitals.


METHODS
Adult patients treated by HD for at least 6 months. Inclusion criteria were: serum albumin concentration < or =39 g/L and at least 4% loss of body weight during the last 6 months in otherwise stable HD patients. From a cohort of 133 patients who were enrolled, 97 (54 men and 43 women) were eligible for the analysis.


METHODS
Intradialytic AA supplementation with 500 mL 10% solution per HD session for a period of 6 months.


METHODS
Serum albumin concentration, modified Subjective Global Assessment (SGA) score, body mass index (BMI), mid-arm circumference (MAC), and total lymphocyte count. Measurements were recorded at baseline and after 3 and 6 months of AA supplementation.


RESULTS
Serum albumin concentration increased significantly from the mean 32.5 +/- 4.6g/L at baseline to 36.4 +/- 4.8 g/L at 3 months (P <.001) and 37.1 +/- 4.8 g/L at final observation (P <.001 versus baseline). Significant correlation was observed between frequency of AA supplementation and serum albumin increase (r = 0.41; P <.0001). Rate of improvement negatively correlated significantly with baseline concentration of serum albumin (r = - 0.42; P <.0001). SGA score significantly improved from median of 16 points at baseline to 12 points at 3 months (P <.01) and 11 points at 6 months (P <.01 versus baseline), and this improvement also correlated with the frequency of AA supplementation. Small yet significant increase of MAC was observed at 6 months (from baseline 24.1 +/- 4.3 to 24.8 +/- 4.8 cm; P <.01), whereas BMI remained unchanged.


CONCLUSIONS
Intradialytic AA supplementation improves selected nutritional parameters of HD patients with malnutrition. The improvement depends on the intensity of supplementation.
Czekalski
Stanislaw
S
Department of Nephrology, Transplantology and Internal Diseases, University of Medical Sciences, Poznań, Poland. sczekals@eucalyptus.usoms.poznan.pl
Hozejowski
Roman
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000008:administration & dosage*; D000886:Anthropometry; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016014:Linear Models; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000150:complications* / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D014508:Urea / Q000097:blood
D000596:Amino Acids; D012709:Serum Albumin; D014508:Urea; D003404:Creatinine