Dialysate as food: combined amino acid and glucose dialysate improves protein anabolism in renal failure patients on automated peritoneal dialysis.
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.
Tjiong
Hoey Lan
HL
Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands. h.tjiong@erasmusmc.nl
van den Berg
Jacobus W
JW
Wattimena
Josias L
JL
Rietveld
Trinet
T
van Dijk
Laurens J
LJ
van der Wiel
Adorée M
AM
van Egmond
Anneke M
AM
Fieren
Marien W
MW
Swart
Roel
R
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
D000596:Amino Acids; D015314:Dialysis Solutions; D011506:Proteins; D005947:Glucose; D009584:Nitrogen