Effects of Amino Acid Dialysis Solution on the Nutrition of Continuous Ambulatory Peritoneal Dialysis Patients

Grzegorzewska, Alicja E.; Mariak, I; Dobrowolska-Zachwieja, Agnieszka; Szajdak, Lech Wojciech

doi:10.1177/089686089901900510

Cited by 25 publications

(18 citation statements)

References 30 publications

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“…(1) and our present study did not reveal, however, a significantly higher ultrafiltration volume in a PET performed after the preceding overnight exchange with PG-DS compared to ultrafiltration volume in a PET following an exchange with glucose dialysis solution. A detailed analysis of water balance in presented patients treated with PG-DS has been published (21). To the contrary, Steele et al .…”

Section: Discussionmentioning

confidence: 99%

Results of Peritoneal Equilibration Test during Treatment with Polyglucose Dialysis Solution

Grzegorzewska

D²,

Leander

2002

Perit Dial Int

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Background Results of peritoneal equilibration test (PET) suggest prolonged effect of polyglucose dialysis solution (PG-DS) on peritoneal permeability. Objectives An evaluation of dialysate-to-plasma ratio (D/P) of urea, D/P creatinine, and D/D0 glucose (ratio of dialysate glucose at designated dwell time to dialysate glucose at 0 dwell time), and mass transfer area coefficients (KBD) of these solutes in PET before introduction, during administration, and after discontinuation of PG-DS in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design Single-center prospective study with PG-DS; retrospective selection of the control group. Setting Peritoneal dialysis unit in a university hospital. Patients Fourteen patients (11 males; age 45.1 ± 8.5 years) treated with CAPD for 17.5 ± 9.9 months. 7.5% PG-DS was used for the overnight exchange. After discontinuation of the PG-DS, standard dialysis solutions, as previously used, were reintroduced. The control group was selected to match both CAPD duration and peritoneal permeability of the patients in the PG-DS group at the start of the study. Methods Standard PET was carried out at 1.6 ± 0.8 months before the introduction of PG-DS (study period I, n = 14), after 1.2 ± 0.6 months’ use of PG-DS (study period II, n = 14), after 4.4 ± 0.8 months’ use of PG-DS (study period III, n = 11), after 8.8 ± 2.2 months’ use of PG-DS (study period IV, n = 9), and at 2.0 ± 0.6 months after PG-DS discontinuation (study period V, n = 11). Patients in the control group underwent PET at similar time intervals (control periods I – V). Results In the PG-DS group, a tendency toward increased peritoneal permeability for urea and creatinine was shown during the consecutive study periods. D/D0 glucose was significantly higher only in the PET performed during use of PG-DS (periods II – IV) compared to results obtained in period I. In the control group, both D/P and KBD of both urea and creatinine remained unchanged, but KBD glucose was higher in the first 2 hours of the PET in control period V compared to respective values in control period III. Conclusion Changes in peritoneal permeability are observed in CAPD patients treated with PG-DS. These changes may be at least partially related to the administration of polyglucose.

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Section: Discussionmentioning

confidence: 99%

Results of Peritoneal Equilibration Test during Treatment with Polyglucose Dialysis Solution

Grzegorzewska

D²,

Leander

2002

Perit Dial Int

Self Cite

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“…24 AA solution improved oxidative phosphorylation of muscle during exercise and recovery in nutritionally unselected stable PD patients. 25 However, there are other studies showing no improvement in nutritional parameters after 6 months use of AA solution in well-nourished CAPD patients despite increased serum concentration of AA 26 or no change in serum albumin level in stable CAPD patients. 27 A 3-year prospective randomized study in malnourished CAPD patients showed that biochemical nutritional parameters including albumin and cholesterol level remained stable or increased in patients using an AA solution once daily, but decreased in patients with conventional dextrose solutions.…”

Section: Nutritional Effects Of Aa Solutionmentioning

confidence: 99%

New insight of amino acid-based dialysis solutions

Park¹,

Choi²,

Song³

et al. 2006

Kidney International

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Malnutrition is a major complication of peritoneal dialysis (PD) and is associated with increased morbidity and mortality. Daily losses of proteins and amino acids (AAs) into dialysate contribute to this problem. Previous metabolic balance study demonstrated that treatment with 1.1% AA-based dialysis solution is safe and may improve protein malnutrition in continuous ambulatory peritoneal dialysis (CAPD) patients ingesting low protein intake. Other prospective studies also showed that AA solution can provide nutritional benefit for malnourished PD patients resulting in a significant improvement in some biochemical and/or anthropometric nutritional parameters. However, there are other studies showing no particular improvement in nutritional parameters after long-term use of AA solution. This may be related to the differences in the study design, sample size, methods used to assess nutritional status, and other factors such as dietary intake and comorbidities of study subjects. Published data will be reviewed to further emphasize the nutritional benefit of long-term use of AA solution in malnourished PD patients along with a brief discussion on the various reasons that may partly explain the different study results. We will also present the results of a longitudinal observational study evaluating changes in nutritional parameters following use of one exchange of 1.1% AA solution in malnourished Korean PD patients. A significant improvement of somatic protein status such as lean body mass (LBM) and hand grip strength was observed. No significant change in serum albumin level was noted. Patients with a positive estimated coefficient for LBM in the fitted regression model to the repeated observations over 1 year were classified as responders and patients with neutral or negative coefficient were considered as non-responders. Thirty-one out of 43 malnourished patients (72%) showed nutritional benefit based on the change of LBM. Hand grip strength and back lift strength were significantly higher in responders at baseline. Other baseline parameters did not differ between the two groups.

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“…22,42 The clinical disadvantages of AA DS include in creased generation of urea and uric acid, elevat ed plasma homo cysteine levels, gastrointestinal symptoms and decreased serum bic levels. 24,47 The clinical disadvantages of dialysis solu tions with physio logical pH occur very seldom and include meta bolic alkalosis, occasionally ob served with solutions containing higher bic lev els (39 mmol/l). 48 Combined effects of the PG -ds, AA -ds and neutral pH/low GdP solution Trials designed to show the advantages of PG DS, AA DS combined with those of neutral solutions have been pub lished.…”

Section: References Peritoneal Dialysis Technique Survivalmentioning

confidence: 99%