Abstract: TH-PO0486
Dialysis Prescription to Minimize Amino Acid Loss During Hemodialysis Sessions
Session Information
- Hemodialysis: Novel Markers and Case Reports
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Miyamoto, Tetsu, Kidney Center, University of Occupational and Enviromental Health School of Medicine, Kitakyushu, Japan
- Shirouzu, Tomohiro, 2nd Department of Internal Medicine, Unibersity of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
Background
Protein energy wasting (PEW) in patients undergoing hemodialysis (HD) is influenced by numerous factors, including nutrient leakage during dialysis. It is particularly crucial to mitigate nutrient leakage in elderly HD patients who already experience PEW and have insufficient dietary intake. Although there is extensive literature on albumin leakage during HD, reports on amino acid leakage remain limited. This study aimed to assess the extent of amino acid leakage during HD and identify dialysis conditions that may reduce such leakage.
Methods
In six patients on maintenance hemodialysis, the concentrations of 20 amino acids were measured by continuous collection of dialysate effluent during HD under five dialysis conditions, and the leakage volume and clear space were measured. The dialysis time was 4 h, membrane area was 1.5 m2, blood flow rate (Qb) was 250 ml/min, and the dialysate flow rate (Qd) was 600 ml/min. 1) HD using cellulose triacetate membrane (CTA group), 2) HD using polysulfone membrane (PS group), 3) HD using AN69 membrane (AN69 group), (4) Pre online hemodiafiltration (OHDF) with Qd 100ml/min and filtration flow rate (Qs) 200ml/min (Low Qd group), (5) OHDF with Qd 100ml, Qb 150ml/min and Qs200ml (Low Qd & Qb groups).
Results
The leakage and clear space of total amino acids were 8.2(6.8-10.0)g , 23 (19-27)L in the CTA group, 7.9(6.1-9.5)g, 20 (12-29)L in the P S group, 7.3(7.0-7.7)g , 2 1 (18-26)L in the AN69 group, 8.1(6.7- 9.1)g, 21(17-26)L in the Low Qd group, 6.2(5.0-6.8)g,15 (13-18)L in the Low Qd & Q b group, and 8.1(6.7- 6.8)g, 11 (17-18)L in the L ow Qd & Q b group. Leakage volume was significantly reduced only in the Low Qd & Qb groups (P=0.004). The leakage of essential (P=0.004) and branched chain amino acids (P=0.001) was comparable.
Conclusion
Under standard dialysis conditions, the depletion of amino acids ranged from 6 to 10 grams per session. For HD patients who exhibit protein-energy wasting (PEW), it is essential to provide a nutritional prescription that addresses the associated amino acid loss. To mitigate amino acid leakage during hemodialysis, it is advisable to adopt strategies that focus on reducing the diffusion efficiency of small molecules, rather than solely depending on membrane materials. Additionally, online hemodiafiltration (HDF) with decreased dialysate and blood flow rates may be considered as a viable option.