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Peritoneal Dialysis with Solutions Containing Amino Acids Plus Glucose Promotes Protein Synthesis during Oral Feeding

Hoey Lan Tjiong^*, Trinet Rietveld^*, Josias L. Wattimena^*, Jacobus W. van den Berg^*, Devada Kahriman^*, José van der Steen^*, Wim C. Hop, Roel Swart^*, and Marien W. Fieren^*

Departments of ^* Internal Medicine and Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands

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

Inadequate food intake plays an important role in the development of malnutrition. Recently, an increased rate of protein anabolism was shown in fasting state in patients who were on automated peritoneal dialysis with combined amino acids (AA) and glucose (G) dialysate serving as a source of both proteins and calories. This study investigated the effects of such a dialysis procedure in the daytime in the fed state in patients who were on continuous ambulatory peritoneal dialysis (CAPD). A crossover study was performed in 12 CAPD patients to compare, at 7-d intervals, a mixture of AA (Nutrineal 1.1%) plus G (Physioneal l.36 to 3.86%) versus G only as control dialysate. Whole-body protein turnover was studied by primed constant intravenous infusion of ¹³C-leucine during the 9-h dialysis. For meeting steady-state conditions during whole-body protein turnover, frequent exchanges with a mixture of AA plus G were done using an automated cycler. Fed-state conditions were created by identical liquid hourly meals. Using AA plus G dialysate, as compared with the control, rates of protein synthesis increased significantly (2.02 ± 0.08 versus 1.94 ± 0.07 µmol leucine/kg per min [mean ± SEM]; P = 0.039). Rates of protein breakdown and net protein balance did not differ significantly between AA plus G and G. In conclusion, dialysate that contains AA plus G also improves protein synthesis in fed CAPD patients. The use of such a mixture may contribute to long-term improvement of the nutritional status in malnourished CAPD patients with deficient food intake.

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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]