Replacement of Amino Acid and Protein Losses with 1.1% Amino Acid Peritoneal Dialysis Solution

Abstract

Objective Losses of nutrients into dialysate may contribute to malnutrition. Peritoneal dialysis (PD) patients are reported to lose 3 -4 g/day of amino acids (AAs) and 4 -15 g/day of proteins. The extent to which one exchange with a 1.1% AA dialysis solution (Nutrineal, Baxter, Deerfield, IL, U.s.A.) offsets these losses was investigated in a 3-day inpatient study in 20 PD patients. Design Simple, open-label, cross-over study on consecutive days in a clinical research unit. On day 1 all patients were given a peritoneal equilibration test (PET). On day 2 they received 1.5% dextrose Dianeal (Baxter) as the first exchange of the day and their usual regimen thereafter. On day 3, the first exchange of the day was the 1.1% AA solution in place of 1.5% Dianeal and the usual PD regimen thereafter. On days 2 and 3 all dialysate effluent was collected and analyzed for AAs and proteins. Patients were maintained on a constant diet. Results Losses of AAs and total proteins on day 2 were 3.4 ± 0.9 g and 5.8 ± 2.4 g, respectively, totaling 9.2 ± 2.7 g. The net uptake of AAs on day 3 was 17.6 ± 2.6 g (80 ± 12% of the 22 g infused). Mean gains of AAs on day 3 exceeded losses of proteins and AAs on day 2, p < 0.001. Losses of total proteins, but not losses of AAs, and the net absorption of AAs from the dialysis solution were correlated directly with peritoneal membrane transport characteristics, obtained from the PET. Conclusion Daily losses of AAs and proteins into dialysate are more than offset by gains of AAs absorbed from one exchange with 1.1% AA-based dialysis solution. Net gains of AAs exceeded losses of proteins and AAs in all patients studied. The difference was relatively constant across a wide range of membrane transport types. Net AA gains were approximately two times the total AA and protein losses.

The effectiveness of oral essential aminoacids and aminoacids containing dialysate in peritoneal dialysis

“…During the exchange period of 2 L of 1.1% AAC dialysate (4-6 h), approximately 80% ($18 g) of AAs is absorbed from the peritoneal membrane. 7,22 This AAs replacement may contribute AA's recruitment in PD patients who are experiencing malnutrition. Many studies have revealed improvements in nutritional parameters, such as a significant increase in serum protein, albumin levels, nitrogen balance, BMI and recovery of plasma AAs profile after 1.1% AAC dialysate initiation in PD patients.…”

The history of peritoneal dialysis: Early years at Toronto Western Hospital

“…Patients on CAPD usually loose 4 to 8 g of proteins per day and 2.0 to 2.5 g of amino acid to the peritoneal membrane 20…”

“…It has been demonstrated that the infusion of a solution containing amino acids (2 L of 1.1%) during one exchange results in an average amino acid absorption of 17.6 g/day, that is twice as large as the dialysate losses of amino acids and proteins (on average 9.2 g/day) 20. Treatment with intraperitoneal amino acid solution results in a positive nitrogen balance, a significant increase in net protein anabolism, and more normal fasting plasma amino acid pattern, and significant increases in serum total protein and transferring 21.…”

Intradialytic Parenteral Nutrition and Intraperitoneal Nutrition

“…[17][18][19] Likewise, peritoneal dialysis patients can lose 5-15 g of protein per day. 20 Because of the severe restrictions imposed by the renal diet, including fruits, vegetables, dairy, and fluids, patient compliance with the diet can also lead to challenges. When oral liquid supplements are used in an effort to increase oral nutrient intake, taste fatigue can develop, reducing patient acceptance and consumption.…”