Combined amino-acid and glucose peritoneal dialysis solution for children with acute renal failure

Peritoneal dialysis (PD) solutions with amino acids (AAs) were developed as an alternative to glucose-based PD solutions for chronic renal failure. Although AA solution has many theoretical advantages, the results reported in the literature are still not convincing. Treatment of ARF is a complex problem. To tackle it, we investigated a PD solution based on a mixture of Nutrineal (Baxter Healthcare SA, Castlebar, Ireland) and Dianeal (Baxter Healthcare SA), mixed on the heating plate of the PAC Xtra cycler (Baxter Healthcare SA). The resulting solution was expected to lower the glucose load without affecting dialysis adequacy. We retrospectively analyzed data in children treated with the mixture, and evaluated safety, dialysis adequacy, acidosis, and nutritional state (albumin). Glucose reabsorption and protein losses were significantly lower when mixed AA-glucose solution was used. Despite significant AA absorption in the patients, we observed no significant difference in plasma albumin levels. Reabsorption from the dialysate of AAs varied between 21% and 69%, resulting in 27% +/- 12% of daily AA intake. Reabsorption of glucose from the dialysate was 32% - 72%. In children in intensive care, who are often already very sensitive, an AA-containing mixture may help to control glycemia, subsequently reducing the need for insulin. Our data demonstrate that the calculated percentage reabsorption of glucose and AAs is high and that AA levels in plasma remain stable. Although our data do not demonstrate a potential influence on final outcome, they demonstrate the feasibility and safety of using combined AA-glucose solution, with a calculated resorption that lends nutritional support.