This article appears in the following NDT Plus issue: Dialysis Initiatives May 2007, Berlin, Germany [View the issue table of contents]
Dialysate as food as an option for automated peritoneal dialysis
Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
Correspondence: M. W. J. A. Fieren, Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Tel: +31107040704; Fax: +31107033324; E-mail: m.fieren{at}erasmusmc.nl
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Abstract |
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Protein-energy malnutrition is frequently found in dialysis patients. Many factors play a role in its development including deficient nutrient intake as a result of anorexia. Peritoneal dialysis (PD) solutions containing a mixture of amino acids and glucose in an appropriate ratio could serve as a source of food. The authors of this article found that such a dialysis solution when administered to fasting patients who were on nightly automated peritoneal dialysis (APD), as part of a regular dialysis schedule, induced an acute anabolic effect. Also in PD patients in the fed state, dialysis solutions containing both amino acids and glucose were found to improve protein metabolism. It appears that the body responds similar to intraperitoneal and oral amino acid:dialysate as food. Like dietary proteins, intraperitoneal amino acids can bring about generation of hydrogen ions and urea as a result of oxidation. No rise of serum urea levels was found and serum bicarbonate remained within the normal range when a total buffer concentration of 40 mmol/L in the mixture was used. The use of this approach may be an option for PD patients who cannot fulfil dietary recommendations.
Key Words: amino acid dialysate • malnutrition • metabolic acidosis • peritoneal dialysis
Received for publication February 19, 2008. Accepted for publication June 19, 2008.