Differences and Effects of Metabolic Fate of Individual Amino Acid Loss in High-Efficiency Hemodialysis and Hemodiafiltration
| Autor: | Paolo Iadarola, Piergiorgio Bolasco, Roberto Aquilani, Maria Luisa Deiana, Romina Secci, Mariella Cadeddu, Stefano Murtas |
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| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Cachexia Time Factors medicine.medical_treatment 030232 urology & nephrology Nutritional Status Medicine (miscellaneous) Hemodiafiltration 03 medical and health sciences 0302 clinical medicine Renal Dialysis Valine Internal medicine medicine Humans Amino Acids Dialysis Aged Aged 80 and over chemistry.chemical_classification 030109 nutrition & dietetics Nutrition and Dietetics business.industry Middle Aged medicine.disease Amino acid Glutamine Endocrinology chemistry Nephrology Sarcopenia Hemodialysis Leucine business |
| Zdroj: | Journal of Renal Nutrition. 30:440-451 |
| ISSN: | 1051-2276 |
| DOI: | 10.1053/j.jrn.2019.12.003 |
| Popis: | Objective The objective of the study was to quantify the loss and arterial blood concentration of the three main classes of amino acids (AAs)—nonessential amino acids (NEAAs), essential amino acids (EAAs), and branched-chain amino acids—as resulting from high-efficiency hemodialysis (HED) and hemodiafiltration (HDF). We moreover aimed to identify the different fates and metabolic effects manifested in patients undergoing hemodialysis and the consequences on body composition and influence of nutritional decline into protein energy wasting. Design and Methods Identical dialysis monitors, membranes, and dialysate/infusate were used to ensure consistency. Ten patients were recruited and randomized to receive treatment with on-line modern HED and HDF. Arterial plasma concentrations of individual AAs were compared in healthy volunteers and patients undergoing hemodialysis, and AA levels outflowing from the dialyzer were evaluated. Baseline AA plasma levels of patients undergoing hemodialysis were compared with findings obtained 1 year later. Results A severe loss of AA with HED/HDF was confirmed: a marked loss of total AAs (5 g/session) was detected, corresponding to more than 65% of all AAs. With regard to individual AAs, glutamine displayed a consistent increase (+150%), whereas all other AAs decreased after 12 months of HD/HDF. Only a few AAs, such as proline, cysteine, and histidine maintained normal levels. The most severe metabolic consequences may result from losses of EAAs such as valine, leucine, and histidine and from NEAAs including proline, cysteine, and glutamic acid eliciting the onset of hypercatabolism threatening muscle mass loss. Conclusion Dialysis losses, together with the effect of chronic uremia, resulted in a reduction of fundamental EAAs and NEAAs, which progressively led our patients after 12 months to a deterioration of lean mass toward sarcopenia. Therefore, the reintroduction of a correctly balanced AA supplementation in patients undergoing HD to prevent or halt decline of hypercatabolism into cachexia is recommended. |
| Databáze: | OpenAIRE |
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