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Abstract: PO2034

Continuous Intradialytic Amino Acid Infusion from the Start of Dialysis Is Better to Avoid Catabolism Under the High-Volume Pre-Dilution Online Hemodiafiltration

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Kato, Motoko, Department of Clinical Engineering, Eijin Clinic, Hiratsuka, Japan
  • Urabe, Shunichiro, Department of Clinical Engineering, Eijin Clinic, Hiratsuka, Japan
  • Kitajima, Yukie, Tokyo University of Technology School of Health Sciences, Setagaya, Japan
  • Kokubo, Kenichi, Allied Health Science, Kitasato University, Sagamihara, Japan
  • Hyodo, Toru, Dialysis Center, Eijin Clinic, Hiratsuka, Japan
Background

Amino acid infusion during dialysis is useful for improving nutritional status (Clin Nephrol 3:234,1975). Usually, amino acid is infused 60 to 90 minutes before the end of dialysis, but it is reported that continuous administration from the start of dialysis is better (Kidney Int 21: 500, 1982). Moreover, these effects are unclear in the high-volume pre-dilution on-line HDF (HVPO-HDF). The optimal administration method of amino acid infusion under the HVPO-HDF was analyzed.

Methods

The subjects were 10 patients receiving HVPO-HDF (7 males, 4 diabetics, mean age: 77.2±5.5 years). We compared the pre- and post-dialysis plasma amino acids levels and the total amino acids amount in the waste fluid when the amino acids infusion was performed from the start of dialysis (Group A) and from 1 hour before the end of dialysis (Group B). The treatment time is 4 hours. The mean blood flow rate was 200 mL/min. The dialysate flow rate was 600 mL/min. The replacement fluid flow rate was 400 mL/min and total replacement fluid volume was 90. Hemodiafilter MFX-21Meco (Nipro, Ltd) was used.

Results

In pre-dialysis plasma levels of total amino acid (TAA), Group A and Group B showed the same level (2472±267 nmol/mL and 2623±319 nmol/mL, respectively). In the essential amino acid (EAA) and non-essential amino acid (NEAA), similar results were obtained (827±145 nmol/mL and 847±99 nmol/mL of EAA, 1644±216 nmol/mL and 1120±193 nmol/mL of NEAA, respectively). Moreover, the losses of amino acids were also same (9008±113 mg and 8886±1204 mg of TAA, 4966±579 mg and 4544±453 mg of EAA, 4042±644 mg and 4342±862 mg of NEAA, respectively). However, in Group A, post-dialysis plasma levels of amino acids were significantly lower than in Group B (2066±370 nmol/mL and 3826±636 nmol/mL of TAA, 946±193 nmol/mL and 2249±439 nmol/mL of EAA, 1120±193 nmol/mL and 1577±260 nmol/mL of NEAA, respectively. p < 0.01).

Conclusion

The result of high post-dialysis plasma levels despite the same loss of amino acids suggests more catabolism from muscle to blood in Group B. The continuous intradialytic amino acid infusion from the start of dialysis is better to avoid catabolism under HVPO-HDF.