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End-stage renal disease patients lose a substantial amount of amino acids during hemodialysis
Hendriks, Floris K. Smeets, Joey S. J. Broers, Natascha J. H. van Kranenburg, Janneau M. X. van der Sande, Frank M. Kooman, Jeroen P. van Loon, Luc J. C.
Hendriks, Floris K.
Smeets, Joey S. J.
Broers, Natascha J. H.
van Kranenburg, Janneau M. X.
van der Sande, Frank M.
Kooman, Jeroen P.
van Loon, Luc J. C.
Abstract
Background
Poor nutritional status is frequently observed in end-stage renal disease patients and associated with adverse clinical outcomes and increased mortality. Loss of amino acids (AAs) during hemodialysis (HD) may contribute to protein malnutrition in these patients.
Objective
We aimed to assess the extent of AA loss during HD in end-stage renal disease patients consuming their habitual diet.
Methods
Ten anuric chronic HD patients (mean ± SD age: 67.9 ± 19.3 y, BMI: 23.2 ± 3.5 kg/m2), undergoing HD 3 times per week, were selected to participate in this study. Spent dialysate was collected continuously and plasma samples were obtained directly before and after a single HD session in each participant. AA profiles in spent dialysate and in pre-HD and post-HD plasma were measured through ultra-performance liquid chromatography to determine AA concentrations and, as such, net loss of AAs. In addition, dietary intake before and throughout HD was assessed using a 24-h food recall questionnaire during HD. Paired-sample t tests were conducted to compare pre-HD and post-HD plasma AA concentrations.
Results
During an HD session, 11.95 ± 0.69 g AAs were lost via the dialysate, of which 8.26 ± 0.46 g were nonessential AAs, 3.69 ± 0.31 g were essential AAs, and 1.64 ± 0.17 g were branched-chain AAs. As a consequence, plasma total and essential AA concentrations declined significantly from 2.88 ± 0.15 and 0.80 ± 0.05 mmol/L to 2.27 ± 0.11 and 0.66 ± 0.05 mmol/L, respectively (P < 0.05). AA profiles of pre-HD plasma and spent dialysate were similar. Moreover, AA concentrations in pre-HD plasma and spent dialysate were strongly correlated (Spearman's ρ = 0.92, P < 0.001).
Conclusions
During a single HD session, ∼12 g AAs are lost into the dialysate, causing a significant decline in plasma AA concentrations. AA loss during HD can contribute substantially to protein malnutrition in end-stage renal disease patients. This study was registered at the Netherlands Trial Registry (NTR7101).
Keywords
protein, muscle wasting, nutrient loss, kidney disease, chronic hemodialysis patients
Date
2020
Type
Journal article
Journal
The Journal of Nutrition
Book
Volume
150
Issue
5
Page Range
1160-1166
Article Number
ACU Department
Centre for Exercise and Nutrition
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY 4.0
File Access
Open