Effects of Parenteral Infusion of Amino Acid Solutions in Acid-Base Balance in Patients with Advanced Chronic Renal Failure

Abstract

Malnutrition is a very common condition in patients with chronic kidney disease (CKD), especially after the 3 rd stage (GFR 30-59 mL/min/1.73 m 2 ). It affects virtually every organ and the function of the entire organism as well and therefore influences the survival. Moreover, the supplementation of amino acids could correct the negative nitrogen balance of those patients improving their survival rates, while little is known regarding any possible negative effect of this supplementation of amino acids on the acid-base balance.We investigated the impact of parenteral infusion of two different kinds of amino acid solutions (specific for CKD patients and nonspecific) in 25 patients (12F, 13M), suffered from chronic renal failure in stages 3 and 4 (GFR 16 to 45.1 mL/min/1.73 m 2 ). The specific for uremic CKD patients solution A was administrated for 5 days, and after an interval of one week, we treated the same patients for another 5 days with the second non-specific solution B, with usual composition), in order to investigate their influence on patients' acid-base balance. Comparing the results of the first and the last infusion of solution A, neither pH nor blood gases analysis presented significant differences, while solution B induced statistically significant changes in both pH and blood gases, (p=0.0001). Acidosis was resulted in by the reduction of serum levels of HCO 3 -whereas not any significant change observed in serum lactate levels after the infusion of each solution.These results suggest that for patients with chronic kidney disease in stages 3 and 4 who require the administration of a supplementary amino acid solution, the CKD-specific solution A may be preferred, since it prevents the worsen of the metabolic acidosis, which is commonly present in these patients.

Evaluation of Y-site compatibility of home total parenteral nutrition and intravenous loop diuretics

“…The differential buffer composition of nephro solutions is very important because it could prevent worsening of metabolic acidosis, which is a common complication in uremic patients. [7] Metabolic acidosis is related to negative nitrogen balance as well as enhanced protein catabolism. In a chronic condition, it also suppresses albumin synthesis.…”