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Perit Dial Int 3(2): 66-72 1983
© 1983 International Society for Peritoneal Dialysis
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REVIEWS AND ORIGINAL ARTICLES

EFFECTIVE USE OF AMINO ACID DIALYSATE OVER FOUR WEEKS IN CAPD PATIENTS

Arie Oren, George Wu, G. Harvey Anderson, Errol Marliss, Ramesh Khanna, Jean Pettit, Lou Mupas, Helen Rodella, Lidia Brandes, Daniel A. Roncari, Gary Kakis, Joan Harrison, Kenneth McNeil and Dimitrios G. Oreopoulos

From the Department of Medicine, Toronto Western Hospital and the Departments of Medicine and Nutritional Sciences, University of Toronto

We studied the effectiveness, tolerance to, and beneficial metabolic effects of amino acid dialysate over an intermediate period in six CAPD patients. Two liters of 1% amino acid solution (Amino-Dianeal) were alternated with dialysate containing glucose. After four weeks there were significant increases in BUN (from 64 to 102 mg%), total body nitrogen (from 1333 to 1380 g), serum transferrin (from 175 to 222 mg%) and anion gap (from 15.1 to 17.3). Initially, there was a significant rise in HDL cholesterol, however, this was not sustained. No significant change was detected in total-body potassium, fasting serum albumin, triglyceride, insulin, glucagon, electrolytes, anthropometric measurements and daily ingestion of calories and proteins. During the study individual fasting, plasma amino acid levels showed significant increments in respect to histidine, tryptophan and glycine but alanine decreased. Several essential amino acids continued to show values below normal. Two hours after consumption of breakfast and concurrent infusion of the amino acid solution, the plasma levels of the amino acids in the dialysate peaked at two to three times the baseline value. Plasma insulin also peaked then at three times the baseline level. There was a simultaneous rise in plasma glucagon, but plasma glucose excursion was minimal. The ultrafiltration effect of 1% Amino-Dianeal was intermediate between those of 1.5% and 2.5% glucose Dianeal. In conclusion, two daily exchanges of 1% Amino-Dianeal solution over one month were: (I) well tolerated; (2) induced no adverse cumulative effects on fasting or postinfusion plasma amino acid concentrations; and (3) improved the nutritional status of the patients as indicated by an increase in TBN and serum transferrin.






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