Peritoneal protein losses and cytokine generation in automated peritoneal dialysis with combined amino acids and glucose solutions.
OBJECTIVE
Protein-energy malnutrition as a consequence of deficient protein intake frequently occurs in peritoneal dialysis (PD) patients. Previously, we showed that peritoneal dialysate containing a mixture of amino acids (AA) and glucose has anabolic effects. However AA-dialysate has been reported to increase intraperitoneal protein and AA losses and the release of proinflammatory cytokines (interleukine-6 (IL-6) and tumor necrosis factor alpha (TNFalpha)). We investigated the effect of AA plus glucose (AAG) solutions on peritoneal protein losses and cytokine generation.


METHODS
In 6 patients on standard automated peritoneal dialysis (APD) 12 APD sessions of 6 cycles each were performed during the night using dialysate containing 1.1% AA plus glucose or glucose alone as control. Protein losses and TNFalpha and IL-6 concentrations were measured in dialysates separately collected from nightly cycling and daytime dwell.


RESULTS
The 24 hour-protein losses with AAG (median 6.7 g, range 4.7-9.4 g) were similar to control dialysate (median 6.0 g, range 4.2-9.2 g). Daytime dialysate IL-6 levels were higher after nightly AAG dialysis than after control dialysis (142 pg/ml and 82 pg/ml, respectively, P<.05). TNFalpha concentrations were very low.


CONCLUSIONS
Nightly APD with amino acids containing dialysate was associated with an increase in peritoneal IL-6 generation during the day. The addition of AA to standard glucose dialysis solutions did not induce a significant increase of peritoneal protein losses.
Tjiong
H L
HL
Department of Internal Medicine, Erasmus MC, 3015 CE Rotterdam, The Netherlands. h.tjiong@erasmusmc.nl
Zijlstra
F J
FJ
Rietveld
T
T
Wattimena
J L
JL
Huijmans
J G M
JG
Swart
G R
GR
Fieren
M W J A
MW
D000328:Adult; D001331:Automation; D002097:C-Reactive Protein / Q000378:metabolism; D018592:Cross-Over Studies; D016207:Cytokines / Q000096:biosynthesis* / Q000378:metabolism; D015314:Dialysis Solutions / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D015850:Interleukin-6 / Q000096:biosynthesis*; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
D016207:Cytokines; D015314:Dialysis Solutions; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D005947:Glucose