The Use of an Amino-acid-based CAPD Fluid over 12 Weeks

Abstract

Eight patients with end-stage renal failure (plasma albumin less than 35 g/l) who were established on glucose CAPD exchanges, were studied for 4-week periods before, and after 12 weeks when 1% amino-acid solution had been used for the morning exchange. Anthropometric, biochemical, clinical and dietary assessments were made every 4 weeks. Dietary intakes of protein and calories were maintained. Studies with amino-acid solutions showed a mean of 13% and 8% amino acids remaining in the dialysate after 6 and 8 h respectively. Plasma amino acids increased to a maximum after 2 h of dialysis; however, fasting concentrations were constant over the 5 months. Osmolality of amino acids decreased comparably with 1.36% glucose during 8-h exchanges although the recovery of fluid was marginally less. Plasma transferrin increased significantly after 8 weeks of amino acids but subsequently decreased in one patient due to infection. No significant changes occurred in albumin, apolipoprotein A, IgG, IgA or prealbumin. Cholesterol and apolipoprotein B decreased in seven patients but increased in one due to rising calorie intake. Increases in urea and decreases in bicarbonate were not clinically significant. Amino-acid-based fluid was well tolerated with modest nutritional benefit and reduction in hyperlipidaemia. Optimal effects of amino acids are likely at higher concentrations using two or more exchanges in patients eating less than 0.9 g protein/kg per day.

Effect of Peritoneal Dialysis Solution Type on Serum Lipid Levels in End-Stage Renal Disease

“…[21] Patients in the present study were selected according to their PD type, and no difference was observed according to their nutritional status. Also, the amino acidbased PD fluid used in this study differed in chemical composition from that of the fluid used by Young et al [18] and Bruno et al [19] in that it had a higher (1.1%) amino acid content, a higher osmolality (365 mosm/L), and was more biocompatible (lactate content 40 mmol/L, pH 6.7). These findings are in agreement with four other smaller studies.…”

“…Two studies reported a decrease in plasma cholesterol. [18,19] In one of these studies, there was no change in serum triglycerides over 12 weeks, [18] whereas a rise in serum triglycerides has been reported by another study. [20] In the present study, although serum triglyceride and cholesterol levels of patients on amino acid-based PD were lower than glucose-based PD, this was not significant.…”

“…The reasons for variance in these studies are hard to define. Young et al [18] analyzed eight patients with a serum albumin of 35 gr/L, whereas Bruno et al studied six patients who were overweight and Misra et al selected their patients (n=18) on the basis of their serum cholesterol rather than their nutritional status. [21] Patients in the present study were selected according to their PD type, and no difference was observed according to their nutritional status.…”

Dialysate as Food

“…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).…”

Muscle Metabolism in Uremia and the Effect of Amino Acid Supplementation

“…When well-balanced AA solutions were given together with a high caloric meal, the administration of AA-containing dialysate improved nutritional parameters, including an increase in serum proteins [146], normalization of plasma AA profile [150], increase in nitrogen balance [151] and weight gain [150] in malnourisched patients. In most studies, nitrogen excretion and plasma urea increased simultaneously, suggesting that a large part of the absorbed AAs are directly oxidized and used to sustain resting energy expenditure [150, 152, 153, 154, 155]. Intraperitoneal AA administration can also aggravate metabolic acidosis [150, 152, 153, 155] leading to defective incorporation into muscle and immediate oxidation.…”