Abstract
Purpose: Among patients end-stage renal disease who receive peritoneal dialysis, malnutrition is an strong predictor of increased morbidity and mortality rates. In cases with malnutrition, hypoalbuminemia occurs mainly due to the leakage of albumin through peritoneal membrane. Therefore, the current study aimed to investigate and compare the effects of intraperitoneal or oral amino acid supplements in preventing hypoalbuminemia. 1.2 1.2 Method: Our study included 36 patients on continuous ambulatory peritoneal dialysis (CAPD) in our center. In one group, one of the exchanges was replaced with a daily dose of 2000ml of peritoneal dialysis solution with 1.1% amino acids (AAs). The other group was given oral supplementation of keto/amino acids. The group receiving intraperitoneal (IP) AAs was composed of 16 patients, while oral keto/amino acid group included 20 patients. The baseline levels of serum albumin, prealbumin, transferrin, CRP, CO2, cholesterol panels and weights (recorded during PET) were compared with the values measured after 6 months of treatment. Results: The baseline albumin levels in the IP AA group were lower than the Oral AA group (p=0.008). When we categorized the patients based on their peritoneal membrane permeability, we found no difference between the peritoneal membrane permeability values of the groups and their laboratory variables (p>0.05). At the end of month 6, the BUN levels significantly elevated in the group receiving IP AA solution, whereas their levels of phosphorus and HDL declined (p <0.05). The group receiving oral AAs supplement had lower levels of albumin and HbA1C at the end of month 6 (p <0.05). Conclusion: Although treatment with AAs supplements administered either intraperitoneally or orally, can be considered a good nutritional support, it should be borne in mind that the important point is to increase the amount of dietary protein intake in individual patients.
Highlights
Among patients with ESRD (End-Stage Renal Disease) who receive peritoneal dialysis treatment, the prevalence of protein-energy malnutrition (PEM) is considerably high and it is regarded as a strong predictor of increased morbidity and mortality rates
Conclusion: treatment with amino acids (AAs) supplements administered either intraperitoneally or orally, can be considered a good nutritional support, it should be borne in mind that the important point is to increase the amount of dietary protein intake in individual patients
The current study showed that neither intraperitoneal AAs solution nor oral keto/amino acid supplement had a positive contribution to the biochemical markers of nutrition such as albumin, prealbumin, and transferrin
Summary
Among patients with ESRD (End-Stage Renal Disease) who receive peritoneal dialysis treatment, the prevalence of protein-energy malnutrition (PEM) is considerably high and it is regarded as a strong predictor of increased morbidity and mortality rates. In routine monitoring of patients with end-stage renal disease, the most prevalent instrument is the measurement for biochemical value of serum albumin level, where both lower intakes of certain nutrients and systemic inflammation are commonly associated with protein-energy wasting among dialysis dependent renal failure patients, which may lead to hypoalbuminemia [7,8]. Data from the most recent energy expenditure research show that, in accordance with the guidelines provided by the KDOQI, patients treated with peritoneal dialysis need a daily energy intake ranging from 30 to 35 kcal/kg based on their age [10]. Amino acid losses into dialysate during continuous ambulatory peritoneal dialysis (CAPD) range from 2 to 4 g, while 5-15 grams of proteins such as albumin, immunoglobulin, complement, transferrin, ß2-microglobulin, and α2macroglobulin are lost [12,13,14] during a 24-hour collection period [5,6]
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