Effects of 1.1% Amino Acid PD Solution in Diabetic Malnourished PD Patients

Object: Malnutrition is a major complication of peritoneal dialysis (PD) patients. Recent studies have indicated that approximately 50% of PD patients show anthropometric and biochemical evidences for malnutrition, especially in diabetic patients. Since malnutrition status does put patients at great risk for morbidity and mortality, this issue becomes of considerable clinical importance. We try to elevate the effect of Nutrineal on our PD patients. Materials and Methods: A peritoneal dialysis solution containing 1.1% amino acids as the osmotic agent was evaluated in a 3-month randomized, prospective, open-label parallel group study in diabetic malnourished PD patients. All patients showed subjective global assessment (SGA) and biochemical (albuminM3.5g/dl) evidences for malnutrition. Thirty-three PD patients were randomized onto the study. Twenty of 33 patients (group I) received one 2.0 L bag of 1.1% amino acids solution for the second exchange in place of glucose solutions and 13 patients (group II) received their usual therapy with four dextrose exchange. The anthrometric marker, serum albumin, transferrin, total protein, plasma amino-acid profile, IGF1, SGA were followed up to elevate the nutritional benefits. Result: In our study, the prevalence rate of malnutrition was 67.90% (36/53)in diabetic PD patients and 34.53%(48/139)in the nondiabetic patients. Nine patients (6 in group I and 3 in group II) dropped out before completing the 3-month study. In group I, two patient was withdrawn for surgery, one for stroke, 3 for poor compliance. In group II, two patients were withdrawn for peritonitis and one for COPD and respiratory failure. Plasma Albumin and dry weight didn’t change after the 2 months treatment. There were significant decrease in the serum potassium (3.9+1.02 mmol/L to 3.49+0.67 mmol/L)and phosphate (5.95+3.58 mmol/L to 4.63+2.40 mmol/L in the group I. but no changes in the group II. Conclusion: The failure to find an increase in amino acids solution in the recurrent study may be explained by the failure to increase dietary protein, the timing of samples, or the dose of AA-based dialysate used. The plasma albumin may be not a good nutritional marker. We will follow up with other multiple markers for greater accuracy. Further study about A.A-base solution is necessary.