Effective Use of Amino Acid Dialysate over four Weeks in CAPD Patients

Abstract

We studied the effectiveness, tolerance to, and beneficial metabolic effects of amino acid dialysate over an intermediate period in six CAPD patients. Two liters of 1% amino acid solution (Amino-Dianeal) were alternated with dialysate containing glucose. After four weeks there were significant increases in BUN (from 64 to 102 mg%), total body nitrogen (from 1333 to 1380 g), serum transferrin (from 175 to 222 mg%) and anion gap (from 15.1 to 17.3). Initially, there was a significant rise in HDL cholesterol, however, this was not sustained. No significant change was detected in total-body potassium, fasting serum albumin, triglyceride, insulin, glucagon, electrolytes, anthropometric measurements and daily ingestion of calories and proteins. During the study individual fasting, plasma amino acid levels showed significant increments in respect to histidine, tryptophan and glycine but alanine decreased. Several essential amino acids continued to show values below normal. Two hours after consumption of breakfast and concurrent infusion of the amino acid solution, the plasma levels of the amino acids in the dialysate peaked at emia, which develops in almost onehalf of the CAPD patients (7), and the significant weight gain observed in some of them. Furthermore, the daily losses of albumin and amino acids in the dialysate may induce protein malnutrition, especially if these losses are not replaced by an adequate daily protein intake. The presence of protein malnutrition in CAPD patients is indicated by the low serum albumin and total protein, and by the decrease in total body nitrogen over one year of CAPD (8).

Peritoneal Dialysis with Amino Acid Solutions: Fluid and Solute Transport Kinetics

“…The present results agree with those of two previous reports (7,8). Williams et al (7) have reported that peritoneal dialysis with a 2% amino acid solution resulted in an average ultrafiltration volume of 571 ml during 6 h dwell, compared with 566 ml for Dianeal glucose 4.25%.…”

“…Oren et a]. (8) have reported that the use of a 1% amino acid solution (two liters per day alternated with dialysis fluid containing glucose) over 4 weeks in 6 CAPD patients resulted in an average increase in BUN levels by 60% whereas the changes in fasting plasma amino acid levels were small. On the other hand, the present results show that the hyperglycemic stress during CAPD with glucose solutions can be decreased by using amino acid solutions.…”

“…To overcome these problems and to improve the nutritional status of CAPD patients, it has been suggested that amino acids should be substituted for glucose as osmotic agents in peritoneal dialysis fluids (5,6). By now, there are some reports on the use of amino acid solutions in peritoneal dialysis (7)(8)(9)(10). However, peritoneal diffusive transport and ultrafiltration characteristics during dialysis with amino acid solutions have not been studied in detail. To further evaluate the potential clinical role of amino acids as osmotic agents for peritoneal dialysis, we have investigated the transport of fluid and solutes through the peritoneal barrier during a single cycle of peritoneal dialysis with solutions containing either amino acids or glucose.…”

PD solutions: New and old

“…46 Oreopoulos and colleagues studied the effects of amino acid-containing solutions in an attempt to reduce amino acid losses from the peritoneal effl uents and prevent hypertriglyceridemia and obesity. 47,48 These early studies suggested that amino acids could be potential osmotic agents without interfering with nitrogenous waste removal. Increased levels of albumin, pre-albumin, and transferrin have been observed after 1-3 months of treatment with amino acid dialysate in hypoalbuminemic PD patients.…”

“…51 In addition, signifi cant and progressive increase in blood urea nitrogen (BUN) concentrations and the possible development of clinical metabolic acidosis have been observed with the use of amino acidcontaining PD solutions. 47,[53][54][55][56] Glucose-based biocompatible solutions. New glucose-based biocompatible solutions are available in double-or triple-chamber bags, where the glucose is separated from the buffer and electrolyte components.…”