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Original Research Communications |
1 From the Departments of Nephrology and Biochemistry and the Research Unit, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain, and the Research Unit, Hospital Ramón y Cajal, Madrid.
Background: Malnutrition is highly prevalent in hemodialysis patients. Amino acid (AA) losses during the dialysis procedure may be a contributing factor.
Objectives: The objectives of this study were 1) to prospectively evaluate AA losses and their effect on plasma AA concentrations during dialysis with polyacrylonitrile at baseline and after administration of AAs by intradialysis and 2) to investigate the effects of intradialytic AA supplementation on nutritional status.
Design: Seventeen stable patients without diabetes who were receiving hemodialysis were studied. In the first phase, AA losses were evaluated over 2 wk in 10 patients randomly assigned to receive AA supplementation. AA losses were analyzed during the first week without supplementation and during the second week with AA administration. In the second phase, the patients' nutritional status was investigated after 3 mo of AA supplementation and was compared with those in 7 patients not receiving AAs.
Results: Mean (
± SD) AA losses during a 4-h dialysis session were 12 ± 2 g; there was a significant decrease in plasma AA concentrations (386 ± 298 µmol/L for essential and 902 ± 735 µmol/L for nonessential AAs). After administration of AAs, the losses increased to 28 ± 4 g. However, this procedure produced a positive net balance of AAs (10.6 ± 5.6 g for total AAs), preventing a reduction in plasma concentrations. After 3 mo of AA administration, there was a significant increase in protein catabolic rate and serum albumin and transferrin. This improvement occurred without any change in the dialysis dose, ruling out the possibility that an increase in dialysis efficiency played a role.
Conclusions: Intradialysis adequately provides AA supplements, prevents reductions in plasma AA concentrations, and favorably affects the nutritional status of patients receiving hemodialysis.
Key Words: Albumin • amino acid losses • amino acid supplementation • malnutrition • nutritional status • end-stage renal disease • hemodialysis • men and women • Spain
This article has been cited by other articles:
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  N. J.M. Cano, D. Fouque, H. Roth, M. Aparicio, R. Azar, B. Canaud, P. Chauveau, C. Combe, M. Laville, X. M. Leverve, et al. Intradialytic Parenteral Nutrition Does Not Improve Survival in Malnourished Hemodialysis Patients: A 2-Year Multicenter, Prospective, Randomized Study J. Am. Soc. Nephrol., September 1, 2007; 18(9): 2583 - 2591. [Abstract] [Full Text] [PDF]
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 N. W Solomons, P. Stehle, and P. Furst Where is the glutamine? Intradialytic supplementation may not solve all issues in amino acid balance Am. J. Clinical Nutrition, November 1, 2000; 72(5): 1236 - 1237. [Full Text] [PDF]
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J. F Navarro and C. Mora Reply to NW Solomons et al Am. J. Clinical Nutrition, November 1, 2000; 72(5): 1237 - 1237. [Full Text] [PDF]
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J. F Navarro and C. Mora Reply to W Druml Am. J. Clinical Nutrition, November 1, 2000; 72(5): 1238 - 1239. [Full Text] [PDF]
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W. Druml Amino acid losses during intradialytic parenteral nutrition Am. J. Clinical Nutrition, November 1, 2000; 72 (5): 1237 - 1238. [Full Text] [PDF]
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