Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients.

Pupim LB, Flakoll PJ, Brouillette JR, Levenhagen DK, Hakim RM, Ikizler TA
J Clin Invest. 2002 110 (4): 483-92

PMID: 12189242 · PMCID: PMC150418 · DOI:10.1172/JCI15449

Decreased dietary protein intake and hemodialysis-associated protein catabolism are among several factors that predispose chronic hemodialysis (CHD) patients to protein calorie malnutrition. Since attempts to increase protein intake by dietary counseling are usually ineffective, intradialytic parenteral nutrition (IDPN) has been proposed as a potential therapeutic approach in malnourished CHD patients. In this study, we examined protein and energy homeostasis during hemodialysis in seven CHD patients at two separate hemodialysis sessions, with and without IDPN administration. Patients were studied 2 hours before, during, and 2 hours following a hemodialysis session, using a primed constant infusion of L-(1-(13)C) leucine and L-(ring-(2)H(5)) phenylalanine. Our results showed that IPDN promoted a large increase in whole-body protein synthesis and a significant decrease in whole-body proteolysis, along with a significant increase in forearm muscle protein synthesis. The net result was a change from an essentially catabolic state to a highly positive protein balance, both in whole-body and forearm muscle compartments. We conclude that the provision of calories and amino acids during hemodialysis with IDPN acutely reverses the net negative whole-body and forearm muscle protein balances, demonstrating a need for long-term clinical trials evaluating IDPN in malnourished CHD patients.

MeSH Terms (18)

Amino Acids Cross-Over Studies Energy Metabolism Female Forearm Homeostasis Humans Infusions, Parenteral Kidney Failure, Chronic Leucine Male Middle Aged Muscle, Skeletal Oxidation-Reduction Phenylalanine Protein-Energy Malnutrition Proteins Renal Dialysis

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