No abstract
Inadequate food intake plays an important role in the development of malnutrition. Recently, an increased rate of protein anabolism was shown in fasting state in patients who were on automated peritoneal dialysis with combined amino acids (AA) and glucose (G) dialysate serving as a source of both proteins and calories. This study investigated the effects of such a dialysis procedure in the daytime in the fed state in patients who were on continuous ambulatory peritoneal dialysis (CAPD). A crossover study was performed in 12 CAPD patients to compare, at 7-d intervals, a mixture of AA (Nutrineal 1.1%) plus G (Physioneal l.36 to 3.86%) versus G only as control dialysate. Whole-body protein turnover was studied by primed constant intravenous infusion of 13 C-leucine during the 9-h dialysis. For meeting steady-state conditions during whole-body protein turnover, frequent exchanges with a mixture of AA plus G were done using an automated cycler. M any patients who are on peritoneal dialysis (PD) develop protein-energy malnutrition (1,2). Inflammation, acidosis, insulin resistance, insufficient intake of proteins and calories as a result of anorexia, and peritoneal losses of proteins and amino acids (AA) contribute to protein-energy malnutrition (3-5). A strong association between malnutrition, inflammatory parameters, and cardiovascular mortality has been reported (6 -10). However, it is not understood completely how these factors are related causally.Dialysate that contains AA was introduced to compensate for low protein intake and protein losses (11-13). The use of AAcontaining dialysate was shown to be most effective when intraperitoneal AA were supplied simultaneously with sufficient oral calories (14 -18). However, anorexia in continuous ambulatory PD (CAPD) patients prevents adequate oral intake of protein and calories. Recently, we showed improved protein anabolism in fasting patients who were on PD with dialysate that contained AA plus glucose (G) (18).The daily cycle of fasting and feeding plays a key role in whole-body protein homeostasis. In this study, we examined the metabolic effects of AA plus G (AAG) dialysis in PD patients to determine whether the AAG mixture could contribute to protein anabolism in the fed state. This could be of clinical relevance especially when daily protein and calorie intake of CAPD patients is insufficient. Effects of AAG dialysate on protein metabolism were studied using whole-body protein turnover (WBPT). Because metabolic steady-state conditions are not achieved with a standard CAPD scheme, frequent dialysate exchanges were done using an automated cycler. The dialysis took place during the day while the patients consumed liquid food hourly in identical portions. This was a randomorder crossover study in 12 patients to compare AAG dialysate with G dialysate as a control at 1-wk intervals. Materials and Methods PatientsTwelve CAPD patients were recruited from the PD Unit of the Erasmus Medical Center. Inclusion criteria called for stable patients who were on PD for Ͼ3 mo and h...
Objectives. 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 (TNFα)). 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 TNFα 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). TNFα concentrations were very low. Conclusion. 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.
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