A Novel Amino Acids Oral Supplementation in Hemodialysis Patients: a Pilot Study

Abstract

Background: Protein malnutrition and lowering serum albumin is frequent in hemodialysis patients. A special amino acid formulation has recently been used with favorable effects in elderly people but no data exist in renal patients. Aim: To assess the effects of this novel amino acid formulation in stable hemodialysis patients with reduced albumin levels. Methods: Thirty stable hemodialysis patients with serum albumin levels <3.5 g/dL, normalized protein nitrogen appearance (nPNA) <1.1 g/kg/d, and body mass index (BMI) >20 kg/m 2 were selected: 15 patients were randomized to oral amino acid supplementation (4 g thrice a day) for 3 months and 15 patients comparable for age, gender, and dialysis durations formed the control group. Biochemistry and bioimpedentiometry parameters were measured at baseline and at the end of treatment. Results: No difference was observed between study group and control group at baseline. At the end of the study period, no change occurred in the studied parameters in the control group, whereas increase in serum albumin (3.1 ± 0.3 vs. 3.6 ± 0.2 g/dL, p < 0.001) and in total proteins (5.7 ± 0.4 vs. 6.4 ±0.7 g/dL, p < 0.001) occurred in the study group. Hemoglobin rose from 10.7 ± 0.9 to 11.7 ± 0.8 g/dL (p < 0.05) at the same erythropoiesis-stimulating agent (ESA) dosage. C-Reactive protein (CRP) levels decreased in the study group (8.7 ± 7.3 vs. 3.8 ± 3.1 mg/L, p < 0.01). Increase of body weight and of equilibrated protein catabolic rate (ePCR) was observed in the study group. Conclusions: Oral amino acids supplementation was able to improve albumin and total protein in hypoalbuminemia hemodialysis patients. This effect was associated with reduction of CRP levels that is with lowering of pro-inflammatory status and anemia improvement.

Dietary supplementation with essential amino acids boosts the beneficial effects of rosuvastatin on mouse kidney

“…These results are consistent with recent studies showing that both Rvs treatment and EAAm supplementation had beneficial effects on kidneys in rodents (Corsetti, et al 2010) and humans (Vidt et al 2006; Bolasco et al 2011). Although data on the potential renal toxicity of high-potency statins are controversial (Tiwari 2006; Golomb and Evans 2008; Dodiya et al 2011), two meta-analyses showed that statin therapy is safe and effective in preventing mortality and major cardiovascular events in patients with non-dialysis-dependent chronic kidney disease (CKD) (Upadhyay et al 2012, 2013; Palmer et al 2012).…”

“…However, these studies provide very limited evidence to support the use of statins in patients on dialysis, and statin therapy was not found to be effective in reducing the risk of kidney failure or decline in kidney function (Upadhyay 2013). Conversely, a recent pilot study conducted in 15 CKD patients on hemodialysis treatment for at least 6 months has shown that 3 month EAAm supplementation increased serum albumin and total proteins, with reduced levels of inflammatory markers and improved anemia (Bolasco et al 2011). Although these effects were studied in a small group of patients and might be due to ameliorated nutrient intake besides that of the amino acid mixture, EAAm supplementation might improve the efficacy of statin therapy in dialysis-dependent subjects.…”

“…Supplementation with this EAAm was found to slow renal senescence in rodents (Corsetti, et al 2010) and in hemodialysis patients (Bolasco et al 2011). We have recently demonstrated that this specific amino acid formula restores mitochondrial function and antioxidant responses through eNOS expression, with reduced inflammatory processes, in the organs and tissues of aged rodents (D’Antona et al 2010; Corsetti et al 2011).…”

The Effect of BCAA and ISO-WHEY Oral Nutritional Supplements on Dialysis Adequacy

“…Bolasco et al (2011) (17) stated that nutrition counseling and assessment of dialysis adequacy could be considered the first steps to improve nutritional status, after which protein-based oral nutritional supplements are recommended. In fact, special renal dietary supplements in hemodialysis patients with reduction in protein intake may lead to the improvement of nutrition status and better dialysis adequacy, which will eventually lead to a higher quality of life without the need to use phosphate-binding agents.…”

Malnutrition, Inflammation and Reverse Epidemiology in Hemodialysis Patients

“…Recently, studies have investigated the effects of protein and amino acid supplements on serum albumin levels in HP (Bolasco, Caria, Cupisti, Secci, & Saverio Dioguardi, 2011;Moretti, Johnson, & Keeling-Hathaway, 2009;Taylor et al, 2011). When selecting an appropriate nutritional supplement for HP, phosphorus levels must be taken into consideration as it has been demonstrated that high-protein intake with concurrent lowphosphorus ingestion and normal serum phosphorus levels is associated with the lowest mortality rate among HP (Kalantar-Zadeh et al, 2010).…”