Short-term studies on the use of amino acids as an osmotic agent in continuous ambulatory peritoneal dialysis

Abstract

1. A 1% amino acid dialysis solution with a high concentration of the branched-chain amino acids has been compared with 1.36% glucose in short-term studies. 2. The 1% amino acid solution was as effective an agent as 1.36% glucose with respect to ultrafiltration and clearance of creatinine, urea and potassium. 3. Levels of branched-chain amino acids rose to the upper end of the normal range within 1 h and remained at this level over the entire period of the study. Total and non-essential amino acids had returned to baseline by the end of the cycle. 4. Blood glucose rose to significantly greater levels during the 1.36% glucose exchange than during the 1% amino acid exchange. There was an increase in serum insulin levels during both cycles; this was significantly greater with the 1% amino acid solution than the 1.36% glucose. 5. There was no evidence of short-term metabolic complications with the 1% amino acid solution.

Dialysate as Food

“…The slow rate of AA supply in our study (27 g during 8.5 h) might explain the small increase in protein synthesis rate. In Delarue's study, the additional supply of oral calories simultaneously with AA dialysate induced a decrease in protein breakdown, probably mediated through insulin secretion (16,22,23,29).…”

“…In continuous ambulatory PD (CAPD) patients, amino acid (AA)-containing dialysate has been used to compensate for a low dietary protein intake and loss of AA and proteins through peritoneal clearance (10). Until now, however, no convincing clinical benefits have been demonstrated (11)(12)(13)(14)(15)(16)(17)(18)(19). AA dialysate may lead to significant increase in serum urea levels (11)(12)(13)(14) and metabolic acidosis (11,12,15), a protein catabolic stimulus (20,21).…”

Effect of Alternative Osmotic Agents on Peritoneal Transport

“…However, a few other solutes also have been investigated as alternative osmotic agents in an attempt to solve metabolic problems caused by the high-caloric load in glucosebased peritoneal dialysis [1][2][3][4][5]. In particular, glycerol [6][7][8][9][10] and amino acids [11][12][13][14][15][16] have been intensively studied clinically and in ani mal models. Other low and high molecular weight solutes have also been tested as possi ble osmotic agents for peritoneal dialysis [ i -4 Apart from toxicological, metabolic, and nutritional aspects, the impact of osmotic agents on the peritoneal solute transport dur ing peritoneal dialysis is a clinically important question [1][2][3][4].…”

Encapsulating Peritoneal Sclerosis: Case report and Current Status

“…Various dialysis solutions that do not contain glucose and are based instead on, icodextrin and amino-acids have also been introduced [50,51]. Some studies have described an association between used of icodextrin-based solutions and increased expression of local infl ammatory markers [52], other data suggest that the use of these solutions preserves both peritoneal membrane function and mesothelial cell mass [53].…”