Amino acid kinetics in diabetic patients during hemodiafiltration performed under intradialytic parenteral amino acid nutrition: A preliminary study

Fujiwara, Masako; Ando, Itiro; Nemoto, Tadashi; Ishida, Aki; Abe, Mina; Otsuki, Takeshi; Shishido, You; Imai, Yutaka; Terawaki, Hiroyuki

doi:10.4009/jsdt.52.457

Cited by 2 publications

(4 citation statements)

References 3 publications

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“…Plasma levels of the following molecules were quantified from the samples collected: major components of non-essential AAs (NEAAs) (alanine [Ala], glutamine, and glutamate), three branched-chain AAs (BCAAs) (leucine [Leu], isoleucine [Ile], and valine [Val]), immunoreactive insulin (IRI), and ketone bodies (KB; including 3-hydroxy butyrate and acetoacetate). As glutamine is easily converted to glutamate in normal laboratory settings [8], the sum of glutamine and glutamate levels was evaluated as glutamine-glutamate (Glx) levels. The levels of IRI, AA, and glucose were determined using CLIA, HPLC, and enzymatic methods, respectively.…”

Section: Case Presentation and Methodsmentioning

confidence: 99%

“…There are few studies regarding the change in AA concentration in the blood during HD treatment; representative studies are summarized in Table 3. The plasma levels of AAs were measured before and after each HD session, and the lack of decline in plasma EAA levels during the sessions has already been reported [2,3,8,[28][29][30][31][32]. However, the mechanism underlying EAA behavior remains unclear because plasma AA levels at intermediate time during the session are yet to be observed.…”

Section: Start Of Change 1 H 20-36 Hmentioning

confidence: 99%

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An increase in circulating levels of branched-chain amino acids during hemodialysis with regard to protein breakdown: three case reports

Fujiwara

Ando

Shishido³

et al. 2022

Ren Replace Ther

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Background Hemodialysis (HD) is a protein catabolic event. However, the amino acid (AA) kinetics during HD sessions involved in protein breakdown have not been well investigated in patients with and without diabetes mellitus (DM). Case presentation Three patients (two patients with DM and one patient without DM) underwent fasting HD. Plasma levels of branched-chain AAs (BCAA; leucine, isoleucine, and valine), major non-essential AAs (alanine and glutamine, including glutamate), insulin, and ketone bodies were measured every hour during each HD session. After the start of the HD session, the plasma levels of insulin and all BCAAs dropped simultaneously. There was a significant subsequent increase in the plasma level of leucine and isoleucine levels, while valine levels remained constant. However, the recovery in levels of BCAAs during HD indicated a profound amount of BCAAs entering the blood from body tissues such as muscles. BCAAs may have surpassed their removal by HD. Ketone body levels increased continuously from the start of the sessions and reached high values in patients with DM. Synchronous changes in insulin depletion and an increase in the levels of ketone bodies may indicate disruption of energy metabolism. Conclusions This is the first report to demonstrate the time course of the changes in circulating levels of BCAAs and related metabolites in energy homeostasis during HD. An increase in BCAA levels during HD was found to be due to their transfer from the body tissue which suggested protein breakdown.

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Section: Case Presentation and Methodsmentioning

confidence: 99%

Section: Start Of Change 1 H 20-36 Hmentioning

confidence: 99%

An increase in circulating levels of branched-chain amino acids during hemodialysis with regard to protein breakdown: three case reports

Fujiwara

Ando

Shishido³

et al. 2022

Ren Replace Ther

Self Cite

View full text Add to dashboard Cite

show abstract

“…The plasma levels of the following molecules were quantified in these samples: major components of NEAAs (alanine [Ala], glutamine, and glutamate), three BCAAs (Ile, Leu, Val), glucose, and immunoreactive insulin (IRI). As glutamine is easily converted to glutamate in normal laboratory settings [13,15], the sum of the glutamine and glutamate levels was evaluated as glutamine-glutamate (Glx) levels. In the dialysate samples, three BCAAs, Ala, and Glx were measured using the same method as for blood, and ketone bodies (KB; including 3-hydroxy butyrate and acetoacetate) were measured using quantitative 1 HNMR spectroscopy of dialysate and converted to plasma levels [14][15][16].…”

Section: Case Presentation and Methodsmentioning

confidence: 99%

“…In our previous study regarding the intravenous administration of amino acids (IVAA) with only AA formulation without simultaneous glucose administration to patients with diabetes mellitus during HDF, analysis of AA profiles in plasma and spent dialysate showed in imperfect compensation in individual AAs for the dialysis removal [13]. IVAA is often dispensed along with glucose coadministration in a clinical setting; however, the metabolic effect of additional glucose administration on IDPN has not yet been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Amino acid availability enhanced through glucose coadministration of amino acid supplementation during hemodiafiltration: two case reports

Fujiwara

Ando

Shishido³

et al. 2022

Ren Replace Ther

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Background Intravenous administration of amino acid (AA) formulation (IVAA) as intradialytic parenteral nutrition is widely used for malnourished patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) or hemodiafiltration (HDF). Although various therapy recipes such as AA compositions or simultaneous administration of glucose and/or lipids have been attempted, the specific effects of each recipe on AA behaviors and metabolic consequences have not been well investigated. To clarify the effect of simultaneous glucose administration with IVAA, we investigated the behavior of AAs, insulin as a metabolic hormone, and energy-related metabolites during an HDF session in two patients. Case presentation We aimed to determine the effect of IVAA with or without simultaneous glucose administration. The plasma levels of AAs, branched-chain AAs (leucine, isoleucine, and valine), major nonessential AAs (alanine and glutamine with glutamate), insulin, glucose, and ketone bodies were measured before HDF and at the second hour (prior to the meal in the HDF session). Lost AAs in the spent dialysate were also measured for the first two hours during the HDF session. Conclusion In the absence of glucose administration, plasma AA levels and the loss of AAs in the dialysate increased owing to IVAA, with the increase in plasma levels in ketone bodies occurring because of scarce secretion of plasma insulin. In the presence of glucose administration, plasma levels and the loss of AA decreased even when the same amount of AAs was injected, possibly because of the profound secretion of insulin with a decrease in ketone bodies. The present findings suggest that the metabolic effects of simultaneous glucose administration on IVAAs enhanced AA uptake into the body during HDF sessions, which might increase the effectiveness of IVAAs.

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Amino acid kinetics in diabetic patients during hemodiafiltration performed under intradialytic parenteral amino acid nutrition: A preliminary study

Cited by 2 publications

References 3 publications

An increase in circulating levels of branched-chain amino acids during hemodialysis with regard to protein breakdown: three case reports

An increase in circulating levels of branched-chain amino acids during hemodialysis with regard to protein breakdown: three case reports

Amino acid availability enhanced through glucose coadministration of amino acid supplementation during hemodiafiltration: two case reports

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