Background: Protein malnutrition and lowering serum albumin is frequent in hemodialysis patients. A special amino acid formulation has recently been used with favorable effects in elderly people but no data exist in renal patients. Aim: To assess the effects of this novel amino acid formulation in stable hemodialysis patients with reduced albumin levels. Methods: Thirty stable hemodialysis patients with serum albumin levels <3.5 g/dL, normalized protein nitrogen appearance (nPNA) <1.1 g/kg/d, and body mass index (BMI) >20 kg/m 2 were selected: 15 patients were randomized to oral amino acid supplementation (4 g thrice a day) for 3 months and 15 patients comparable for age, gender, and dialysis durations formed the control group. Biochemistry and bioimpedentiometry parameters were measured at baseline and at the end of treatment. Results: No difference was observed between study group and control group at baseline. At the end of the study period, no change occurred in the studied parameters in the control group, whereas increase in serum albumin (3.1 ± 0.3 vs. 3.6 ± 0.2 g/dL, p < 0.001) and in total proteins (5.7 ± 0.4 vs. 6.4 ±0.7 g/dL, p < 0.001) occurred in the study group. Hemoglobin rose from 10.7 ± 0.9 to 11.7 ± 0.8 g/dL (p < 0.05) at the same erythropoiesis-stimulating agent (ESA) dosage. C-Reactive protein (CRP) levels decreased in the study group (8.7 ± 7.3 vs. 3.8 ± 3.1 mg/L, p < 0.01). Increase of body weight and of equilibrated protein catabolic rate (ePCR) was observed in the study group. Conclusions: Oral amino acids supplementation was able to improve albumin and total protein in hypoalbuminemia hemodialysis patients. This effect was associated with reduction of CRP levels that is with lowering of pro-inflammatory status and anemia improvement.

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Objective: The objective of the study was to quantify the loss of total amino acids (TAAs), nonessential amino acids, essential amino acids, and branched chain amino acids (BCAAs) produced by high-efficiency hemodialysis (HEHD), postdilution hemodiafiltration (HDFpost), and predilution hemodiafiltration (HDFpre) using high ultrafiltration volumes; and to define the specific AA losses registered in HEHD, HDFpost, and HDFpre; to identify a potential metabolic and nutritional decline into protein energy wasting; to compare AA analysis of arterial blood samples taken from healthy controls and patients with end-stage renal disease undergoing hemodialysis. Design and Methods: Identical dialysis monitors, membranes, and dialysate/infusate were used to homogenize extracorporeal body influence. Ten patients were recruited and randomized to receive treatment with HEHD, HDFpost, and HDFpre it was used on-line dialytic water methodologies (OL); patients' AA arterial concentrations were measured at the start and on completion of dialysis; TAA from the dialyzer filter was calculated, and baseline levels were subsequently compared with findings obtained 1 year later. Finally, the results obtained were compared with the data from a study of 8 healthy volunteers conducted using bioimpedance analysis and laboratory blood tests to assess nutritional status. Results: A higher convective dose results in a higher weekly loss of TAA, nonessential AAs, essential AAs, and BCAAs (HEHD: 15.7 g; HDFpost-OL: 16.1 g; HDFpre-OL: 16.3 g, P , .01). After 12 months, the same hemodialys patients showed a reduced body and water intracellular mass and reduced phase angle. Arterial concentrations of TAAs and BCAAs were lower than those detected in healthy subjects (P , .01). Conclusion: The study shows that the AA losses in dialytic liquid are greater after high exchange volume HDF techniques, especially HDFpre. The AA losses are not metabolically compensated, so these increase the derangements of predialytic arterial plasma AA levels. Both AA losses and arterial AA perturbations further worsened body composition already after 12 months of additional dialysis.

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