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Dialysate as Food: Combined Amino Acid and Glucose Dialysate Improves Protein Anabolism in Renal Failure Patients on Automated Peritoneal Dialysis

Hoey Lan Tjiong^*, Jacobus W. van den Berg^*, Josias L. Wattimena^*, Trinet Rietveld^*, Laurens J. van Dijk^*, Adorée M. van der Wiel, Anneke M. van Egmond, Marien W. Fieren^* and Roel Swart^*

^* Internal Medicine; and Dietetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Address correspondence to: Dr. Hoey Lan Tjiong, Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands. Phone: +31-10-4634610; Fax: +31-10-4635092; h.tjiong{at}erasmusmc.nl

Received for publication May 19, 2004. Accepted for publication February 22, 2005.

Protein-energy malnutrition as a result of anorexia frequently occurs in dialysis patients. In patients who are on peritoneal dialysis (PD), dialysate that contains amino acids (AA) improves protein anabolism when combined with a sufficient oral intake of calories. It was investigated whether protein anabolism can be obtained with a mixture of AA plus glucose (G) as a source of proteins and calories during nocturnal automated PD (APD). A random-order cross-over study was performed in eight APD patients to compare in two periods of 7 d each AA plus G dialysate obtained by cycler-assisted mixing of one bag of 2.5 L of AA (Nutrineal 1.1%, 27 g of AA) and four bags of 2.5 L of G (Physioneal 1.36 to 3.86%) versus G as control dialysate. Whole-body protein turnover was determined using a primed continuous infusion of l-[1-¹³C]leucine, and 24-h nitrogen balance studies were performed. During AA plus G dialysis, when compared with control, rates of protein synthesis were 1.20 ± 0.4 and 1.10 ± 0.2 µmol/kg per min leucine (mean ± SD), respectively (NS), and protein breakdown rates were 1.60 ± 0.5 and 1.72 ± 0.3 µmol/kg per min (NS). Net protein balance (protein synthesis minus protein breakdown) increased on AA plus G in all patients (mean 0.21 ± 0.12 µmol leucine/kg per min; P < 0.001). The 24-h nitrogen balance changed by 0.96 ± 1.21 g/d, from –0.60 ± 2.38 to 0.35 ± 3.25 g/d (P = 0.061, NS), improving in six patients. In conclusion, APD with AA plus G dialysate improves protein kinetics. This dialysis procedure may improve the nutritional status in malnourished PD patients.

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				H. L. Tjiong, R. Swart, J. W. Van den Berg, and M. W. Fieren Dialysate as food as an option for automated peritoneal dialysis NDT Plus, October 1, 2008; 1(suppl_4): iv36 - iv40. [Abstract] [Full Text] [PDF]

				H. L. Tjiong, R. Swart, T. Rietveld, J. L. Wattimena, W. C. Hop, M. W. Fieren, and J. W. v. d. Berg Whole-body protein turnover in peritoneal dialysis patients: a comparison of the [15N]glycine end product and the [13C]leucine precursor methods Nephrol. Dial. Transplant., August 1, 2008; 23(8): 2660 - 2665. [Abstract] [Full Text] [PDF]

				H. L. Tjiong, T. Rietveld, J. L. Wattimena, J. W. van den Berg, D. Kahriman, J. van der Steen, W. C. Hop, R. Swart, and M. W. Fieren Peritoneal Dialysis with Solutions Containing Amino Acids Plus Glucose Promotes Protein Synthesis during Oral Feeding Clin. J. Am. Soc. Nephrol., January 1, 2007; 2(1): 74 - 80. [Abstract] [Full Text] [PDF]

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