Peritoneal protein losses and cytokine generation in automated peritoneal dialysis with combined amino acids and glucose solutions

Objectives. Protein-energy malnutrition as a consequence of deficient protein intake frequently occurs in peritonealdialysis (PD) patients. Previously, we showed that peritoneal dialysate containing a mixture of amino acids (AA) and glucosehas anabolic effects. However AA-dialysate has been reported to increase intraperitoneal protein and AA losses and therelease of proinflammatory cytokines (interleukine-6 (IL-6) and tumor necrosis factor alpha (TNFα)). We investigated the effectof 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 eachwere performed during the night using dialysate containing 1.1% AA plus glucose or glucose alone as control.Protein losses and TNFα and IL-6 concentrations were measured in dialysates separately collected from nightlycycling and daytime dwell. Results. The 24 hour-protein losses with AAG (median 6.7 g, range 4.7-9.4 g) were similarto control dialysate (median 6.0 g, range 4.2-9.2 g). Daytime dialysate IL-6 levels were higher after nightly AAGdialysis than after control dialysis (142 pg/ml and 82 pg/ml, respectively, P<.05). TNFα concentrations were very low. Conclusion. Nightly APD with amino acids containing dialysate was associated with an increase inperitoneal IL-6 generation during the day. The addition of AA to standard glucose dialysis solutions did not inducea significant increase of peritoneal protein losses. Copyright

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