Effects of a new mixture of essential amino acids (Aminotrofic®) in malnourished haemodialysis patients

Abstract

The aim of this study was to verify the clinical efficacy of a diet associated with already commercially available oral amino acid functional cluster (AFC) compared to the administration of a diet associated with a nitrogen protein-based supplement (casein) in antagonizing malnutrition in patients with Chronic renal failure (CRF) undergoing haemodialysis. The secondary aim was to assess the changes in protein levels during the acute phase such as the expression of inflammatory cytokines. Twenty patients in haemodialysis aged between 18 and 85 of both genders (13 m, 7f) were recruited, randomized and divided into two groups and treated for 4 months respectively with: (1) oral AFC supplement (*)8 g/die: group A, and (2) oral supplementation of a protein nitrogenous mixture compared to AFC with a casein protein source) of 6.6 g: group P. During the initial assessment and thereafter on a monthly basis all patients underwent the following: Dietary recall 24 h; Anthropometric: Weight, height, BMI, expected dry weight, actual weight; Biochemical: Albumin, transferrin, Na, K, Cl, Ca, P, Mg, long-interval creatinine (Aminotrofic®: Errekappa Euroterapici, Milano) pre-albumin, α1 acid glycoprotein, C reactive protein (CRP), protein nitrogen appearance (PNA); Instrumental: Handgrip strength evaluation, Calorimetry by means of Armband, Bio-impedance analysis (BIA), Spitzer Index (quality of life), Subjective Global Assessment Generated by the patient (PG SGA). Considering the nutritional parameters, no significant differences concerning dry weight emerged between the beginning (T0) and the end (T4) (weight A to T0: kg 64.41 ± 6.34; weight A to T4: kg 64.51 ± 7.05: P = NS; weight P to T0: kg 60.17 ± 11.94; weight P to T4: kg 59.86 ± 11.43: P = NS); biochemical parameters, significant differences were observed only for two parameters: pre-albumin (Pre-albumin A to T0 30.12 ± 7.23; Pre-albumin A to T4: 28.91 ± 5.8; Pre-albumin P to T0 22.51 ± 6.04; Pre-albumin P to T4: 26.10 ± 9.82), and Transferrin (Transferrin A to T0 171.77 ± 28.87 mg/dL, Transferrin A to T4: 181.44 ± 38.83 mg/dL: P < 0.005; Transferrin P to T0 160.29 ± 27.46 mg/dL, Transferrin P to T4: 146.57 ± 24.96 mg/dL: P < 0.005), but not in other parameters. From a nutritional perspective, after 4 months of treatment an increase in protein synthesis was noted in group A compared to group P which was proved by the significant increase of transferrin. This pilot study suggests the AFC oral supplementation may represent a valid alternative to intradialytic parenteral treatment and may also allow for an improvement in blood chemical values and nutritional status.

Irisin and Volume Overload are Associated with Protein Energy Wasting in Peritoneal Dialysis Patients

“…Protein energy wasting (PEW) is prevalent among chronic kidney disease (CKD) patients and dialysis patients, and it is a marker of complications that lead to adverse outcomes in those patients [1,2]. Causes of PEW are complex, including uremia, dialysis intervention (nutrient loss and bio-incompatibility), inadequate nutrient (protein and energy) consumption, hypermetabolism (micro-inflammation), hormone dysregulation (hyperparathyroidism, insulin resistance, and insulin growth factor 1 resistance), as well as social and psychological factors [1][2][3] .…”

“…Causes of PEW are complex, including uremia, dialysis intervention (nutrient loss and bio-incompatibility), inadequate nutrient (protein and energy) consumption, hypermetabolism (micro-inflammation), hormone dysregulation (hyperparathyroidism, insulin resistance, and insulin growth factor 1 resistance), as well as social and psychological factors [1][2][3] . The pathogenesis of PEW is unclear.…”

Comparison of Intradialytic Parenteral Nutrition with Glucose or Amino Acid Mixtures in Maintenance Hemodialysis Patients

“…Muscle wasting affects about 18% to 75% of patients with chronic kidney disease who are undergoing maintenance dialysis [ 1 , 2 ]. Protein-energy wasting (PEW) is diagnosed if a patient has low serum levels of cholesterol, albumin, or transthyretin; reduced body mass; and less muscle mass observed by mid-arm muscle circumference [ 1 , 3 ] Causes of PEW include uremia, dialysis intervention (nutrient loss and biocompatibility), inadequate nutrient (protein and energy) consumption, hypermetabolism (micro-inflammation), hormone dysregulation (hyperparathyroidism, insulin-resistance, and insulin growth factor 1 resistance), and social and psychological factors [ 3 , 4 ]. Lower protein and/or energy intakes than recommended for patients on hemodialysis are associated with higher morbidity and mortality [ 5 ].…”

“…Hemodialysis or peritoneal dialysis of these patients can exacerbate inadequate consumption of nutrients. Each session of hemodialysis reduces the free amino acid levels in plasma by 30%, losing about 10 to 12 g of amino acids [ 4 , 6 ]. Hemodialysis differentially causes the loss of branched-chain amino acids to a greater extent than aromatic amino acids [ 7 ].…”

“…Hemodialysis differentially causes the loss of branched-chain amino acids to a greater extent than aromatic amino acids [ 7 ]. Hemodialysis also removes approximately 200–480 kcal each session [ 4 , 6 ].…”