Nutritional effects of amino acid dialysate (Nutrineal) in CAPD patients

The use of amino acid dialysate (AAD) has been shown to improve the nutritional status of malnourished continuous ambulatory peritoneal dialysis (CAPD) patients. We report on a randomized, prospective, cross-over study evaluating the effects of a single, daily, postprandial 2-L exchange of 1.1% AAD (Nutrineal) on a nutritionally unselected group of 18 stable CAPD patients. Patients in group A (n = 10) were randomized to receive AAD in the initial six months, whereas group B (n = 8) patients received AAD in the final six months of the study. Regular biochemical, hematological, and anthropometric measurements were made. A computerized nutrition score(1) combined anthropometry, serum albumin, and total lymphocyte count. Improved nutritional status was indicated by a decreased score. Mean serum albumin and transferrin did not show a significant rise in either group. However, patients in group A, with a mean serum albumin of less than 30 g/L, showed a significant rise at two months, which persisted at six months (26.8 g/L on entry, 29.0 g/L at two months, 30.1 g/L at six months; p < 0.05 and p < 0.01, respectively). Treatment with AAD showed a trend towards improvement in midarm muscle circumference in both groups (22.9 -23.5 cm, group A; 22.9-23.7 cm, group B). The nutrition score improved in both groups but was significant only in group A (14.6 to 13.1; p = 0.02). These effects of AAD on the nutritional status of CAPD patients need validation in a long-term study to evaluate the effects on morbidity and mortality.