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Long-term effect of amino-acid dialysis solution in children on continuous ambulatory peritoneal dialysis
Insights
Amino acid (AA) dialysis in children with chronic renal failure improved plasma AA profiles but did not alter blood urea nitrogen or anthropometrics. Further adjustments may be needed to impact intracellular AA pools.
Area of Science:
- Pediatric Nephrology
- Nutritional Biochemistry
Background:
- Chronic renal failure (CRF) in children impacts nutritional status.
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment modality for pediatric CRF.
- Metabolic derangements, including amino acid imbalances, are common in CRF.
Purpose of the Study:
- To investigate the effect of amino acid (AA) dialysis on plasma and intracellular AA profiles in children with CRF on CAPD.
- To assess changes in metabolic and anthropometric parameters during AA dialysis.
Main Methods:
- Eight metabolically stable children with CRF on CAPD were studied for 12-18 months.
- Dextrose-based CAPD was used for the first 6 months, followed by substitution of the morning exchange with a 1% AA solution for 6-12 months.
- Plasma and intracellular (polymorphonuclear leucocytes) AA profiles, along with serum biochemistry and anthropometric parameters, were monitored.
Main Results:
- Plasma AA profiles showed improvement with partial correction of essential AA deficiencies during AA dialysis.
- Blood urea nitrogen moderately increased; serum creatinine, uric acid, phosphate, bicarbonate, potassium, lipids, total protein, albumin, and transferrin remained unchanged.
- Anthropometric parameters showed no significant variation.
- Intracellular AA pools in polymorphonuclear leucocytes exhibited severe alterations at baseline with only minor changes post-treatment.
Conclusions:
- Amino acid dialysis in pediatric CAPD patients can partially correct plasma amino acid imbalances.
- Observed improvements in plasma AA profiles may influence organ metabolism.
- Modifications in AA solution composition or dialysis prescription may be necessary to significantly alter intracellular AA pools and nutritional status.
Abstract:
The study involved eight metabolically stable children, with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) whom we followed for 12-18 months. For the first 6 months CAPD was performed with dextrose; for the subsequent 6-12 months the morning exchange was substituted with a 1% amino-acid (AA) solution. The following parameters did not change during the study: serum creatinine, uric acid, inorganic phosphate, serum bicarbonate, potassium, cholesterol, triglycerides, total protein, albumin and transferrin. The only parameter that changed was blood urea nitrogen, which increased moderately. The anthropometric parameters did not show significant variation before and after AA dialysis. The plasma AA profile, which under basal conditions showed lower levels of several essential AAs, improved during the treatment period, with a partial correction of the imbalance. It is possible that this correction of plasma AAs may positively influence the metabolism of some organs such as the brain, muscle and those of the hepatosplanchnic region. The intracellular pool of free AAs, measured in polymorphonuclear leucocytes, was severely altered before the treatment and after 6 and 12 months showed only minor variations. It is possible that some modifications in the proportion of the different AAs in the dialysis solution or an improvement in the concentration or in the number of exchanges per day are necessary in order to change the nutritional status and to modify the intracellular AA pool.