title: Dialysate as food: combined amino acid and glucose dialysate improves protein anabolism in renal failure patients on automated peritoneal dialysis.
abstract: Protein-energy malnutrition as a result of anorexia frequently occurs in dialysis patients. In patients who are on peritoneal dialysis (PD), dialysate that contains amino acids (AA) improves protein anabolism when combined with a sufficient oral intake of calories. It was investigated whether protein anabolism can be obtained with a mixture of AA plus glucose (G) as a source of proteins and calories during nocturnal automated PD (APD). A random-order cross-over study was performed in eight APD patients to compare in two periods of 7 d each AA plus G dialysate obtained by cycler-assisted mixing of one bag of 2.5 L of AA (Nutrineal 1.1%, 27 g of AA) and four bags of 2.5 L of G (Physioneal 1.36 to 3.86%) versus G as control dialysate. Whole-body protein turnover was determined using a primed continuous infusion of L-[1-13C]leucine, and 24-h nitrogen balance studies were performed. During AA plus G dialysis, when compared with control, rates of protein synthesis were 1.20 +/- 0.4 and 1.10 +/- 0.2 micromol/kg per min leucine (mean +/- SD), respectively (NS), and protein breakdown rates were 1.60 +/- 0.5 and 1.72 +/- 0.3 micromol/kg per min (NS). Net protein balance (protein synthesis minus protein breakdown) increased on AA plus G in all patients (mean 0.21 +/- 0.12 micromol leucine/kg per min; P < 0.001). The 24-h nitrogen balance changed by 0.96 +/- 1.21 g/d, from -0.60 +/- 2.38 to 0.35 +/- 3.25 g/d (P = 0.061, NS), improving in six patients. In conclusion, APD with AA plus G dialysate improves protein kinetics. This dialysis procedure may improve the nutritional status in malnourished PD patients.
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands. h.tjiong@erasmusmc.nl
authors.forename: Hoey Lan
authors.initials: HL
authors.lastname: Tjiong
authors.forename: Jacobus W
authors.initials: JW
authors.lastname: van den Berg
authors.forename: Josias L
authors.initials: JL
authors.lastname: Wattimena
authors.forename: Trinet
authors.initials: T
authors.lastname: Rietveld
authors.forename: Laurens J
authors.initials: LJ
authors.lastname: van Dijk
authors.forename: Adorée M
authors.initials: AM
authors.lastname: van der Wiel
authors.forename: Anneke M
authors.initials: AM
authors.lastname: van Egmond
authors.forename: Marien W
authors.initials: MW
authors.lastname: Fieren
authors.forename: Roel
authors.initials: R
authors.lastname: Swart
mesh_terms: D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage*; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000008:administration & dosage*; D005260:Female; D005502:Food; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000178:diet therapy / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism; D015596:Nutrition Assessment; D010530:Peritoneal Dialysis / Q000379:methods*; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology; D011506:Proteins / Q000378:metabolism
chemical_list: D000596:Amino Acids; D015314:Dialysis Solutions; D011506:Proteins; D005947:Glucose; D009584:Nitrogen