American Journal of Clinical Nutrition, Vol 21, 618-625, Copyright © 1968 by The American Society for Clinical Nutrition, Inc.

Low Protein, High Essential Amino Acid Diet for Nitrogen Equilibrium in Chronic Dialysis

¹ From the Departments of Internal Medicine, Emory University, Atlanta, Georgia, and Vanderbilt University, Nashville, Tennessee

A diet based on the Giordano-Giovannetti concept of low total protein, high essential amino acid content to permit nitrogen equilibrium in uremic patients has been developed for use in maintenance hemodialysis. Nitrogen balance studies in anephric dialyzed patients demonstrated negative balance on the basic 20-g protein GG-type diet due to dialysate nitrogen losses. When the high quality protein was increased to a level of 0.8 g/kg, positive nitrogen balance during dialysis was obtained. On the basis of these studies, a diet containing 0.75 g/kg high quality protein has been prescribed for patients on twice-weekly hemodialysis. Observations were made on a group of 10 patients adhering to the diet and another group of 6 patients who did not but ate various amounts of low quality protein. The group adhering to the diet had markedly lower blood urea nitrogen levels, permitting clinically adequate dialysis with only 16-18 hr weekly of passive-flow dialysis. This group showed better performance in increasing serum albumin levels and dry body weight and has a lower transfusion requirement and less pruritus. Although the diet permits

[See table in the PDF file]

nitrogen equilibrium, periods of increased stress result in sharp drops in serum albumin levels, indicating that this level of protein intake permits no nutritional reserve capacity to buffer a catabolic state. Acidosis and hyperkalemia were not problems in either group. The diet is palatable and imposes no economic stress on the patients. The primary usefulness of the diet is that it permits briefer periods of dialysis with less headache, nausea, and vomiting during dialysis. The experience with the diet is admittedly brief, and prolonged observation for evidence of mineral or other nutritional inadequacies is certainly needed.