Combined Amino-Acid and Glucose Peritoneal Dialysis Solution for ...

Vande Walle et al.Patients and methodsWe retrospectively analyzed data in children treatedwith an AA-based PD solution (Nutrineal) mixed withDianeal in a cycler. We evaluated safety, dialysis adequacy,acidosis, and nutritional state (albumin). Weperformed an AA analysis to evaluate whether the socalledNO-related AAs were increased in plasma,which could possibly lead to risk of shock andvasodilatation.The study group consisted of 33 patients who weretreated for ARF for at least 72 hours at our hospitalduring the period 1993 – 2000. The cycler was programmedfor cycles of 10 minutes inflow, 100 minutesdwell time, and 10 minutes outflow. Glucosesolution was used for the first 48 hours. From 48 hoursto 72 hours, the solution combined 1 bag of Nutrineal1.1% and 1 bag of Dianeal 3.86%.We measured the dialysate and plasma AA concentrations(Figure 1), the plasma AA concentrationsbefore and after Nutrineal (Figure 2), and dialysateparameters. We calculated peritoneal reabsorption(glucose and AAs) and determined blood urea nitrogen(BUN), creatinine, serum albumin, body parameters,and dialysis adequacy.227ResultsWe observed no significant differences in plasmacreatinine, BUN, acidosis, or ultrafiltration rate beforeand after use of Nutrineal. Glucose reabsorptionand protein losses were significantly lower whenmixed AA–glucose solution was used. Despite significantAA absorption, we observed no significantdifference in plasma albumin levels. Reabsorptionfrom the dialysate of AAs varied between 21% and69%, resulting in 27% ± 12% of daily AA intake.Reabsorption of glucose from the dialysate was 32% –72%.Figure 1 shows that the relative concentrationsof several AAs were different in dialysate and plasma.The large standard deviations for the measured dialysateconcentrations may be surprising, but theydo not suggest a manufacturing problem. Rather, theyare related to the different size and format of theNutrineal and Dianeal bags, which produce a slightdisequilibrium as the 2 bags pump up to the heatingplate.Figure 2 shows that, after 48 – 72 hours, plasmaAA levels were not significantly changed (especiallyarginine concentration).FIGURE 1Dialysate and plasma levels of amino acids (AA) for the study patients.