Nitrogen balance during intermittent dialysis therapy of uremia

Borah, Michael; Schoenfeld, Patricia Y.; Gotch, Frank A.; Sargent, John; Wolfson, Marsha; Humphreys, Michael H.

doi:10.1038/ki.1978.154

Cited by 406 publications

(131 citation statements)

References 21 publications

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“…These findings are consistent with the report of Borah et al (9), documenting that nitrogen balance is always less on the day of dialysis, and with our own data showing that lengthening the interdialytic interval tends to improve nitrogen balance (10). By measuring arterio-venous amino acid gradient and total blood flow across the leg, Gutierrez and colleagues ( 14) found that 150 min of sham hemodialysis in normal control subjects led to increased amino acid release, suggesting accelerated protein breakdown.…”

Section: Methodssupporting

confidence: 81%

“…Furthermore, Farrell and colleagues (7) and Ward et al (8) noted that urea generation rate, calculated from urea ki-netics, is 30% higher during dialysis than during the interdialytic period. Using metabolic balance technique, Borah et al (9) noted that nitrogen balance is always less on the day of dialysis irrespective of the quantity of protein intake, and we have noted that dialysate nitrogen loss per day tends to be greater when the interdialytic interval is shorter ( 10). None of these studies, however, provide unequivocal evidence of dialysis-induced protein breakdown.…”

Section: Introductionmentioning

confidence: 53%

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The effect of hemodialysis on protein metabolism. A leucine kinetic study.

Lim¹,

Bier²,

Flanigan³

et al. 1993

J. Clin. Invest.

107

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To assess the effect of hemodialysis on protein metabolism, leucine flux was measured in seven patients before, during, and after high efficiency hemodialysis using cuprophane dialyzers and bicarbonate dialysate during a primed-constant infusion of L-I1-'3CIleucine. The kinetics ;Lsmol/kg per h, mean±SDJ are as follows: leucine appearance into the plasma leucine pool was 86±28, 80±28, and 85±25, respectively, before, during, and after dialysis. Leucine appearance into the whole body leucine pool, derived from plasma l1-'3Cla-ketoisocaproate enrichment, was 118±31, 118±31, and 114±28 before, during, and after dialysis, respectively. In the absence of leucine intake, appearance rate reflects protein degradation, which was clearly unaffected by dialysis. Leucine oxidation rate was 17.3±7.8 before, decreased to 13.8±7.8 during, and increased to 18.9±10.3 after dialysis (P = 0.027). Leucine protein incorporation was 101±26 before, was reduced to 89±23 during, and returned to 95±23 after dialysis (P = 0.13). Leucine net balance, the difference between leucine protein incorporation and leucine release from endogenous degradation, was -173±7.8 before, decreased to -28.5±11.0 during, and returned to -18.9±10.3 after dialysis (P < 0.0001). This markedly more negative leucine balance during dialysis was accountable by dialysate leucine loss, which was 14.4±6.2 umol/kg per h. These data suggest that hemodialysis using a cuprophane membrane did not acutely induce protein degradation. It was, nevertheless, a net catabolic event because protein synthesis was reduced and amino acid was lost into the dialysate. (J. Clin. Invest. 1993 91:2429-2436

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Section: Methodssupporting

confidence: 81%

Section: Introductionmentioning

confidence: 53%

The effect of hemodialysis on protein metabolism. A leucine kinetic study.

Lim¹,

Bier²,

Flanigan³

et al. 1993

J. Clin. Invest.

107

View full text Add to dashboard Cite

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“…The seminal findings of Borah et al (5) that nitrogen balance is always more negative or less positive, depending on the intake, on dialysis days compared with nondialysis days greatly influenced the belief that HD is a protein catabolic procedure. Lim et al (6) also reported that nitrogen output, expressed as milligrams per minute, is greater when the interdialytic interval is 2 d as compared with 3 d, suggesting that each HD generates a certain degree of protein catabolism, the effect of which is minimized when the interdialytic interval is lengthened.…”

Section: Nitrogen Balance Combined With Urea Kineticsmentioning

confidence: 99%

Does Hemodialysis Increase Protein Breakdown? Dissociation between Whole-Body Amino Acid Turnover and Regional Muscle Kinetics

Lim¹,

İkizler²,

Raj³

et al. 2005

Journal of the American Society of Nephrology

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Hemodialysis (HD) is a protein catabolic procedure. Whole-body amino acid turnover studies identify dialysate amino acid loss and reduced protein synthesis as the catabolic events; proteolysis is not increased. Regional amino acid kinetics, however, document enhanced muscle protein breakdown as the cause of the catabolism; muscle protein synthesis also increased but to a lesser magnitude than the increment in protein breakdown. This discordance between whole-body and regional kinetics is best explained by the contrasting physiology between the muscle and the liver. During HD, muscle releases amino acids, which then are taken up by the liver for de novo protein synthesis. There seems to be a somatic to visceral recycling of amino acids. Evidence supporting this concept includes the increased fractional synthesis of albumin and fibrinogen during HD. It should be emphasized that region-or organ-specific kinetics vary, and whole-body turnover is a composite of all of the visceral and somatic compartments taken together. Reduced whole-body protein synthesis may be a compensatory adaptation to dialysate amino acid loss with a consequent reduction in plasma amino acid concentration. Notwithstanding the protein catabolic nature of HD, evidence is accumulating that intradialytic nutritional supplementation may blunt its catabolic effect. U ntil recently, uremia was believed to be a protein catabolic state. This view is no longer tenable because numerous whole-body amino acid turnover studies have unequivocally revealed that there is no excess protein catabolism in the chronic renal failure population in the absence of acidosis and/or concomitant illnesses (1). Uremic patients respond to low-protein diets with appropriate downregulation of whole-body proteolysis (2,3). Peritoneal dialysis is protein catabolic primarily because of protein and amino acid losses through the peritoneal effluent (4). The remaining unsettled issue is whether hemodialysis (HD) induces protein catabolism and, if it does, by what mechanism. There are theoretical reasons to believe that HD can augment protein catabolism. These include amino acid loss to the dialysate and cytokinemediated proteolysis as a result of exposure to bio-incompatible membrane and endotoxin-contaminated dialysate, but to date, investigation of protein metabolism using different techniques has yielded conflicting results. J Am Soc Nephrol Protein Metabolism during HD: A Review of the LiteratureThis article reviews the available literature of protein metabolism during HD and proposes a unifying hypothesis to explain the discordant results and diverging conclusions. The work cited in this review is categorized according to the technique used. Nitrogen Balance Combined with Urea KineticsThe seminal findings of Borah et al. (5) that nitrogen balance is always more negative or less positive, depending on the intake, on dialysis days compared with nondialysis days greatly influenced the belief that HD is a protein catabolic procedure. Lim et al. (6) also reported that nitrogen ou...

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“…Maintenance hemodialysis (HD) is a catabolic procedure that is associated with poor nutritional status (1,2). In addition to being catabolic, time spent undergoing treatment provides an added barrier to achieving adequate dietary intake and has been associated with significant reductions in nutrient consumption compared with nontreatment days (3,4).…”

Section: Introductionmentioning

confidence: 99%