Effects of peritoneal dialysis on protein metabolism.
Protein-energy wasting is relatively common in renal patients treated with haemodialysis or peritoneal dialysis (PD) and is associated with worse outcome. In this article, we review the current state of our knowledge regarding the effects of PD on protein metabolism and the possible interactions between PD-induced changes in protein turnover and the uraemia-induced alterations in protein metabolism. Available evidence shows that PD induces a new state in muscle protein dynamics, which is characterized by decreased turnover rates and a reduced efficiency of protein turnover, a condition which may be harmful in stress conditions, when nutrient intake is diminished or during superimposed catabolic illnesses. There is a need to develop more effective treatments to enhance the nutritional status of PD patients. New approaches include the use of amino acid/keto acids-containing supplements combined with physical exercise, incremental doses of intraperitoneal amino acids, vitamin D and myostatin antagonism for malnourished patients refractory to standard nutritional therapy.
Division of Nephrology, Department of Internal Medicine, University of Genoa, Italy; IRCCS San Martino-IST, Genoa, Italy. Electronic address: gari@unige.it.
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Garibotto
Division of Nephrology, Department of Internal Medicine, University of Genoa, Italy; IRCCS San Martino-IST, Genoa, Italy.
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Sofia
Division of Nephrology, Department of Internal Medicine, University of Genoa, Italy; IRCCS San Martino-IST, Genoa, Italy.
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Saffioti
Division of Nephrology, Department of Internal Medicine, University of Genoa, Italy; IRCCS San Martino-IST, Genoa, Italy.
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Bonanni
Division of Nephrology, Department of Internal Medicine, University of Genoa, Italy; IRCCS San Martino-IST, Genoa, Italy.
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Mannucci
Division of Nephrology, Department of Internal Medicine, University of Genoa, Italy; IRCCS San Martino-IST, Genoa, Italy.
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Parodi
Division of Nephrology, Department of Internal Medicine, University of Genoa, Italy; IRCCS San Martino-IST, Genoa, Italy.
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Cademartori
Division of Nephrology, Department of Internal Medicine, University of Genoa, Italy; IRCCS San Martino-IST, Genoa, Italy.
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Verzola
D000596:Amino Acids / Q000378:metabolism; D019587:Dietary Supplements; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy*; D010530:Peritoneal Dialysis; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000378:metabolism*; D011506:Proteins / Q000378:metabolism*
D000596:Amino Acids; D011506:Proteins