Peritoneal dialysis with solutions containing amino acids plus glucose promotes protein synthesis during oral feeding.
Inadequate food intake plays an important role in the development of malnutrition. Recently, an increased rate of protein anabolism was shown in fasting state in patients who were on automated peritoneal dialysis with combined amino acids (AA) and glucose (G) dialysate serving as a source of both proteins and calories. This study investigated the effects of such a dialysis procedure in the daytime in the fed state in patients who were on continuous ambulatory peritoneal dialysis (CAPD). A crossover study was performed in 12 CAPD patients to compare, at 7-d intervals, a mixture of AA (Nutrineal 1.1%) plus G (Physioneal l.36 to 3.86%) versus G only as control dialysate. Whole-body protein turnover was studied by primed constant intravenous infusion of (13)C-leucine during the 9-h dialysis. For meeting steady-state conditions during whole-body protein turnover, frequent exchanges with a mixture of AA plus G were done using an automated cycler. Fed-state conditions were created by identical liquid hourly meals. Using AA plus G dialysate, as compared with the control, rates of protein synthesis increased significantly (2.02 +/- 0.08 versus 1.94 +/- 0.07 mumol leucine/kg per min [mean +/- SEM]; P = 0.039). Rates of protein breakdown and net protein balance did not differ significantly between AA plus G and G. In conclusion, dialysate that contains AA plus G also improves protein synthesis in fed CAPD patients. The use of such a mixture may contribute to long-term improvement of the nutritional status in malnourished CAPD patients with deficient food intake.
Tjiong
Hoey Lan
HL
Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. h.tjiong@erasmusmc.nl
Rietveld
Trinet
T
Wattimena
Josias L
JL
van den Berg
Jacobus W
JW
Kahriman
Devada
D
van der Steen
José
J
Hop
Wim C
WC
Swart
Roel
R
Fieren
Marien W
MW
D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage*; D002247:Carbon Isotopes; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage / Q000493:pharmacokinetics; D004435:Eating; D002149:Energy Intake; D004734:Energy Metabolism / Q000187:drug effects; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy / Q000378:metabolism / Q000628:therapy*; D007930:Leucine / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D014176:Protein Biosynthesis / Q000187:drug effects; D011502:Protein-Energy Malnutrition / Q000000981:diagnostic imaging / Q000178:diet therapy* / Q000378:metabolism; D011877:Radionuclide Imaging
D000596:Amino Acids; D002247:Carbon Isotopes; D015314:Dialysis Solutions; D004044:Dietary Proteins; D007930:Leucine; D005947:Glucose