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Continuous ambulatory peritoneal dialysis (CAPD) of children with amino acid solutions: technical and metabolic
Insights
Continuous ambulatory peritoneal dialysis (CAPD) with amino acid (AA) solutions may improve nutrient status in children. AA solutions limit glucose load and compensate for essential amino acid losses during dialysis.
Area of Science:
- Pediatric Nephrology
- Nutritional Biochemistry
- Renal Replacement Therapy
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for children with kidney failure.
- Nutritional deficiencies, including amino acid (AA) depletion, can occur in CAPD patients.
- Standard dialysis solutions often contain glucose, which can lead to metabolic complications.
Purpose of the Study:
- To compare the effects of amino acid (AA) versus glucose-containing dialysis solutions on plasma AA levels in pediatric CAPD patients.
- To evaluate the absorption and retention of AAs from AA-based dialysis solutions.
- To assess the impact of AA dialysis on overall AA balance and potential benefits for nutritional support.
Main Methods:
- Seven children undergoing CAPD were studied.
- Plasma and dialysate samples were analyzed after dialysis with a 1% AA solution and a 1.36% glucose solution.
- AA levels were measured at various time points (1, 4, and 6 hours).
Main Results:
- Plasma AA levels peaked 1 hour after starting AA dialysis, with significant correlation to the administered AA dose.
- Certain essential AAs (methionine, valine, phenylalanine, isoleucine) remained elevated for up to 4 hours post-AA dialysis.
- Glucose dialysis led to a significant decrease in plasma levels of several AAs, with losses observed in peritoneal effluent.
Conclusions:
- One daily exchange with an AA dialysis solution may limit glucose intake and replenish AAs in pediatric CAPD patients.
- AA dialysis can compensate for AA losses and potentially improve nutritional status.
- The AA profile in plasma after AA dialysis resembles that of a protein meal, without adverse elevations.
Abstract:
The changes in plasma and dialysate amino acids (AA) in 7 continuous ambulatory peritoneal dialysis (CAPD) children after dialysis with a 1% AA solution were compared with a glucose-containing solution. During the AA-exchange, the plasma levels of individual AA reached their peaks after 1 h, with their percentage increments significantly correlated (p less than 0.001) with the ratio of the amount of AA in the bag to the basal plasma concentration. The plasma concentration of methionine, valine, phenylalanine, and isoleucine remained higher than the basal value at 4 h. The amount of AA absorbed was 66% after 1 h, and 86% after 4 h and 6 h, corresponding to 2574 +/- 253 mumol/kg body wt. During glucose-dialysis (1.36%), levels of histidine, methionine, valine, phenylalanine, and isoleucine were significantly decreased in plasma after 1 h, and stayed low throughout the dialysis period. The loss of AA with the peritoneal effluent was 116 +/- 69 mumol/kg/body wt. From this study, it seems that using an AA dialysis solution, with 1 exchange per day, might limit the daily glucose load and compensate for AA losses by supplying an extra amount of AA and by reducing the loss of other AA not contained in dialysis solutions. The AA pattern in plasma following AA-dialysis resembles that observed after a protein meal, with no signs of persistently high, nonphysiological levels.