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Children on continuous ambulatorial peritoneal dialysis: muscle and plasma proteins, amino acids and nutritional
A Canepa1, J C Divino Filho, A M Forsberg
1Department of Nephrology, Istituto Giannina Gaslini, Genova, Italy.
Insights
Children on continuous ambulatory peritoneal dialysis (CAPD) show altered plasma amino acid levels, with essential amino acids reduced and non-essential ones elevated. Muscle amino acid levels were largely similar to controls, indicating complex nutritional changes in pediatric CAPD patients.
Area of Science:
- Pediatric Nephrology
- Nutritional Biochemistry
- Clinical Chemistry
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for pediatric end-stage renal disease.
- Nutritional status is a critical concern in children undergoing CAPD.
- Amino acid (AA) profiles may reflect nutritional derangements in CAPD patients.
Purpose of the Study:
- To investigate plasma and muscle amino acid levels in children on CAPD.
- To explore the relationship between amino acid levels and nutritional status indicators in this population.
Main Methods:
- Evaluated 10 children on CAPD (mean age 6.4 years) and 22 surgical controls.
- Collected muscle biopsies (rectus abdominis) and fasting venous blood samples.
- Measured plasma and muscle intracellular free amino acid concentrations.
- Assessed nutritional status using alkali-soluble protein (ASP)/DNA ratio, serum albumin, transferrin, and body mass index (BMI).
Main Results:
- Plasma essential AA (valine, leucine, isoleucine, lysine, methionine, tyrosine) were significantly reduced in CAPD children compared to controls.
- Plasma non-essential AA (aspartic acid, glycine, citrulline, 1-3 methihystidine, taurine + alanine) were significantly elevated.
- Muscle intracellular free essential AA levels, except valine and leucine, did not differ significantly.
- Muscle non-essential AA (aspartic acid, glutamic acid, ornithine) showed increased intracellular concentrations.
- No significant correlations between AA levels and ASP/DNA ratio, albumin, transferrin, or bicarbonate.
- Muscle ASP/DNA ratio correlated significantly with age (r = 0.714, p < 0.05).
- Muscle Branched Chain Amino Acid (BCAA) levels correlated significantly with BMI (r = 0.648, p < 0.05).
Conclusions:
- Pediatric CAPD patients exhibit distinct alterations in plasma amino acid profiles, characterized by reduced essential and elevated non-essential AA.
- Muscle amino acid composition is relatively preserved, suggesting compartmental differences in AA handling.
- Age and BMI show significant correlations with muscle protein indicators and BCAA levels, respectively, highlighting their importance in nutritional assessment for pediatric CAPD.
- Further research is needed to elucidate the mechanisms behind these AA derangements and their clinical implications.
Abstract:
The aim of the study was to investigate plasma and muscle amino acid (AA) levels in children on continuous ambulatory peritoneal dialysis (CAPD) and their relationship to various indices of nutritional status. Ten children with a mean age of 6.4 +/- 5.6 yrs were evaluated. Muscle biopsies and venous blood samples were taken after an overnight fast. Muscle samples were obtained from rectus abdominis. Data were compared with those of a control group of 22 children who were undergoing elective surgery. Informed consent was obtained from the parents. The plasma concentration of most of the essential AA (valine, leucine, isoleucine, lysine, methionine and tyrosine) were significantly reduced and the levels of some non essential AA (aspartic acid, glycine, citrulline, 1-3 methihystidine, taurine + alanine) were significantly higher than in the controls. Muscle intracellular free essential AA concentrations, except the low levels of valine and leucine did not differ significantly from values in the controls. Among non essential AA, aspartic acid, glutamic acid and ornitine showed significantly increased intracellular concentrations. No significant correlations were found between plasma and muscle AA concentration and ASP (alkali-soluble protein)/DNA ratio, serum albumin, transferrin, bicarbonate levels and duration of CAPD. Instead, a significant correlation was noted between the muscle ASP/DNA ratio, an indicator of the amount of cell proteins per cell unit, and age (r = 0.714, p < 0.05). Muscle Branched chain AA levels were significantly correlated to body mass index (BMI) (r = 0.648, p < 0.05).