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.
|Keywords||Adult, Aged, Amino Acids/*administration & dosage, Cross-Over Studies, Dialysis Solutions/*administration & dosage, Female, Food, Glucose/*administration & dosage, Humans, Kidney Failure, Chronic/complications/diet therapy/*drug therapy, Male, Middle Aged, Nitrogen/metabolism, Nutrition Assessment, Peritoneal Dialysis/*methods, Protein-Energy Malnutrition/diet therapy/drug therapy/etiology, Proteins/metabolism|
|Persistent URL||dx.doi.org/10.1681/ASN.2004050402, hdl.handle.net/1765/13744|
Tjiong, H.L., van den Berg, J.W.O., Wattimena, J.L., Rietveld, T., van Dijk, L.J., Wiel, A.M., … Swart, R.. (2005). Dialysate as food: combined amino acid and glucose dialysate improves protein anabolism in renal failure patients on automated peritoneal dialysis.. American Society of Nephrology. Journal, 16(5), 1486–1493. doi:10.1681/ASN.2004050402