title: Amino acid losses during sustained low efficiency dialysis in critically ill patients with acute kidney injury.
abstract: OBJECTIVE
  Sustained low efficiency dialysis (SLED) involves the use of standard dialysis machines for prolonged intermittent renal replacement therapy in critically ill patients. In this study we aimed to quantify dialysate amino acid (AA) and albumin losses in 5 patients who underwent successful SLED treatment.
  
  
  METHODS
  This was a prospective observational study.
  
  
  METHODS
  The study was performed in a general intensive care unit.
  
  
  METHODS
  The study was performed in critically ill patients with acute kidney injury undergoing SLED using low-flux hemodialyzers.
  
  
  METHODS
  We performed total dialysate collection and measured dialysate AA profiles by reverse phase high-pressure liquid chromatography using an automated AA analyser.
  
  
  METHODS
  Individual and total amino acid losses.
  
  
  RESULTS
  Albumin was undetectable in dialysate. The median (mean ± SD) total amino acid loss was 15.7 (23.4 ± 19.2) g/treatment, or 122.1 (180.6 ± 148.5) mmol/treatment. Two patients were receiving intravenous nutrition. One patient had severe hepatic failure with encephalopathy, and had high dialysate AA levels with a total loss of 57 g/treatment.
  
  
  CONCLUSIONS
  During SLED with low-flux hemodialyzers, albumin losses are negligible but AA losses to dialysate are comparable to those during continuous renal replacement therapy. Patients' nutritional protein prescriptions should be augmented to account for this.
authors.forename: Afia
authors.initials: A
authors.lastname: Umber
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Wolley
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Golper
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Shaver
authors.forename: Mark R
authors.initials: MR
authors.lastname: Marshall
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000097:blood*; D002851:Chromatography, High Pressure Liquid; D056148:Chromatography, Reverse-Phase; D016638:Critical Illness; D015314:Dialysis Solutions / Q000378:metabolism / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D000596:Amino Acids; D015314:Dialysis Solutions; D012709:Serum Albumin; D000075462:Serum Albumin, Human