Protein Catabolic Factors in Patients on Renal Replacement Therapy

The Obsession with High Dietary Protein Intake in ESRD Patients on Dialysis: Is It Justified?

“…Some investigators believe that dialysis-induced protein catabolism is not solely the result of amino acids and/or protein loss into the dialysate but actually increased protein breakdown due to the catabolic effect of proteases and cytokines released during hemodialysis as the result of incompatibility between blood and dialysis membranes [6]. The only concrete evidence for this is the work of Gutierrez et al [19]who showed that circulation of blood of normal subjects through a dialyzer without dialysate (sham dialysis’) leads to proteolysis as documented by an increased extraction of total amino acids from the leg.…”

“…Since the average loss of protein and/or amino acids is about 8 g/day in peritoneal dialysis and 8 g per session in hemodialysis patients [4], the daily intake of protein in dialysis patients needs to be increased only by this magnitude, which is rather modest. Many nephrologists, however, believe that dialysis, specially hemodialysis, is a catabolic process beyond the loss of amino acids and/or protein in the dialysate and thus, these patients should be supplemented with very large amounts of dietary protein [5, 6]. High intake of protein usually means high intake of phosphorus and given the limited capacity of dialysis to remove phosphorus, the need for this high protein intake is an important clinical question for the practicing nephrologist which awaits elucidation.…”

Renal Osteodystrophy: New Insights in Pathophysiology and Treatment Modalities with Special Emphasis on the Insulin-Like Growth Factor System

“…To our knowledge, however, there are no studies to evaluate the use of IGF-1 for this purpose. Some CRF patients and those undergoing maintenance dialysis therapy have a poor nutritional status and display clinical signs of protein catabolism contributing to an increased mortality [204, 205, 206]. IGF-1 treatment in 6 malnourished maintenance peritoneal dialysis patients induced a positive nitrogen balance, a slight decline in serum phosphorus levels (possibly due to increased uptake into bone) and a slight rise in serum calcium levels [207].…”

Cellulose Acetate and Cuprophane for Hemodialysis: Effects on Protein Catabolic Rate

“…On the other hand, bio compatibility may influence the nutritional problems of HD [2], A clinical trial has been performed in which the effects of two cellulosie membranes (cuprophane, CU, and cel lulose acetate. CA) with similar permeability and different biocompatibility [3,4] on the PCR were assessed.…”