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Dombros NV, Prutis K, Tong M, Anderson GH, Harrison J, Sombolos K, Digenis G, Tit JP, Oreopoulos DG. Six-Month Overnight Intraperitoneal Amino-Acid Infusion in Continuous Ambulatory Peritoneal Dialysis (CAPO) Patients-No Effect on Nutritional Status. Perit Dial Int 2020. [DOI: 10.1177/089686089001000120] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The long-term effect of an AA solution based on Tra-vasol®, a solution for total parenteral nutrition, given in-traperitoneally over a 6-month period was studied in 5 patients 22 to 75 years old, having been on continuous ambulatory peritoneal dialysis (CAPD) for 3 to 57 months. A low oral protein intake (<0.8 g/kg bw /day) and/or a low serum albumin «35 g/L) were used as inclusion criteria. Two liters of 1% AA solution were infused overnight, while a glucose Dianeal® was used for the other exchanges. During the study, BUN increased from 22.04 mM/L to 28.06 mM/L the first month and remained at these levels, indicating the increased protein intake. However, average oral total energy and protein intake, body weight (bw), serum creatinine, cholesterol, triglycerides, total proteins, albumin, transferrin, skinfold thickness, total body potassium, and plasma AA levels remained basically unchanged. The average total body nitrogen decreased from 1.746 to 1.554 Kg, but this decrease did not reach statistical significance (p > 0.05). We conclude that intraperitoneal overnight administration of 2 L of 1% AA based on Travasol® over 6 months did not improve the nutritional status of CAPD patients. This ineffectiveness might be due to the AA composition of the solution, the timing of administration, or to a low caloric intake and/or that our patients were not severely malnourished.
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Affiliation(s)
| | - Krystyne Prutis
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mathew Tong
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - G. Harvey Anderson
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joan Harrison
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kostas Sombolos
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - George Digenis
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jean Pet Tit
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Oren A, Wu G, Anderson GH, Marliss E, Khanna R, Tit JP, Mupas L, Rodella H, Brandes L, Roncari DA, Kakis G, Harrison J, McNeil K, Oreopoulos DG. Effective Use of Amino Acid Dialysate over four Weeks in CAPD Patients. Perit Dial Int 2020. [DOI: 10.1177/089686088300300206] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We studied the effectiveness, tolerance to, and beneficial metabolic effects of amino acid dialysate over an intermediate period in six CAPD patients. Two liters of 1% amino acid solution (Amino-Dianeal) were alternated with dialysate containing glucose. After four weeks there were significant increases in BUN (from 64 to 102 mg%), total body nitrogen (from 1333 to 1380 g), serum transferrin (from 175 to 222 mg%) and anion gap (from 15.1 to 17.3). Initially, there was a significant rise in HDL cholesterol, however, this was not sustained. No significant change was detected in total-body potassium, fasting serum albumin, triglyceride, insulin, glucagon, electrolytes, anthropometric measurements and daily ingestion of calories and proteins. During the study individual fasting, plasma amino acid levels showed significant increments in respect to histidine, tryptophan and glycine but alanine decreased. Several essential amino acids continued to show values below normal. Two hours after consumption of breakfast and concurrent infusion of the amino acid solution, the plasma levels of the amino acids in the dialysate peaked at emia, which develops in almost onehalf of the CAPD patients (7), and the significant weight gain observed in some of them. Furthermore, the daily losses of albumin and amino acids in the dialysate may induce protein malnutrition, especially if these losses are not replaced by an adequate daily protein intake. The presence of protein malnutrition in CAPD patients is indicated by the low serum albumin and total protein, and by the decrease in total body nitrogen over one year of CAPD (8).
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Affiliation(s)
- Arie Oren
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - George Wu
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - G. Harvey Anderson
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Errol Marliss
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Ramesh Khanna
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Jean Pet Tit
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Lou Mupas
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Helen Rodella
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Lidia Brandes
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Daniel A. Roncari
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Gary Kakis
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Joan Harrison
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Kenneth McNeil
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
| | - Dimitrios G. Oreopoulos
- From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto
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