End-Stage Renal Disease Patients Lose a Substantial Amount of Amino Acids during Hemodialysis

Floris K. Hendriks; Joey S. J. Smeets; Natascha J. H. Broers; Janneau M. X. van Kranenburg; Frank M. van der Sande; Jeroen P. Kooman; Luc J. C. van Loon

doi:10.1093/jn/nxaa010

End-Stage Renal Disease Patients Lose a Substantial Amount of Amino Acids during Hemodialysis

Floris K. Hendriks, Joey S. J. Smeets, Natascha J. H. Broers, Janneau M. X. van Kranenburg, Frank M. van der Sande, Jeroen P. Kooman, Luc J. C. van Loon^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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/m(2)), 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 gwere 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. = 0.92, P <0.001).

Conclusions: During a single HD session, similar to 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.

Original language	English
Pages (from-to)	1160-1166
Number of pages	7
Journal	Journal of Nutrition
Volume	150
Issue number	5
DOIs	https://doi.org/10.1093/jn/nxaa010
Publication status	Published - May 2020

Keywords

protein
muscle wasting
nutrient loss
kidney disease
chronic hemodialysis patients
MUSCLE PROTEIN-SYNTHESIS
CHRONIC KIDNEY-DISEASE
INTERNATIONAL SOCIETY
CONSENSUS STATEMENT
WHEY-PROTEIN
NUTRITION
ENERGY
DIALYSIS
SUBSEQUENT
INGESTION

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Cite this

@article{17c295490bec45b9a10503e34e9bb70b,

title = "End-Stage Renal Disease Patients Lose a Substantial Amount of Amino Acids during Hemodialysis",

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/m(2)), 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 gwere 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. = 0.92, P <0.001).Conclusions: During a single HD session, similar to 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.",

keywords = "protein, muscle wasting, nutrient loss, kidney disease, chronic hemodialysis patients, MUSCLE PROTEIN-SYNTHESIS, CHRONIC KIDNEY-DISEASE, INTERNATIONAL SOCIETY, CONSENSUS STATEMENT, WHEY-PROTEIN, NUTRITION, ENERGY, DIALYSIS, SUBSEQUENT, INGESTION",

author = "Hendriks, {Floris K.} and Smeets, {Joey S. J.} and Broers, {Natascha J. H.} and {van Kranenburg}, {Janneau M. X.} and {van der Sande}, {Frank M.} and Kooman, {Jeroen P.} and {van Loon}, {Luc J. C.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) on behalf of the American Society for Nutrition 2020.",

year = "2020",

month = may,

doi = "10.1093/jn/nxaa010",

language = "English",

volume = "150",

pages = "1160--1166",

journal = "Journal of Nutrition",

issn = "0022-3166",

publisher = "Oxford University Press",

number = "5",

}

TY - JOUR

T1 - End-Stage Renal Disease Patients Lose a Substantial Amount of Amino Acids during Hemodialysis

AU - Hendriks, Floris K.

AU - Smeets, Joey S. J.

AU - Broers, Natascha J. H.

AU - van Kranenburg, Janneau M. X.

AU - van der Sande, Frank M.

AU - Kooman, Jeroen P.

AU - van Loon, Luc J. C.

N1 - Publisher Copyright: © The Author(s) on behalf of the American Society for Nutrition 2020.

PY - 2020/5

Y1 - 2020/5

N2 - 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/m(2)), 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 gwere 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. = 0.92, P <0.001).Conclusions: During a single HD session, similar to 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.

AB - 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/m(2)), 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 gwere 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. = 0.92, P <0.001).Conclusions: During a single HD session, similar to 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.

KW - protein

KW - muscle wasting

KW - nutrient loss

KW - kidney disease

KW - chronic hemodialysis patients

KW - MUSCLE PROTEIN-SYNTHESIS

KW - CHRONIC KIDNEY-DISEASE

KW - INTERNATIONAL SOCIETY

KW - CONSENSUS STATEMENT

KW - WHEY-PROTEIN

KW - NUTRITION

KW - ENERGY

KW - DIALYSIS

KW - SUBSEQUENT

KW - INGESTION

U2 - 10.1093/jn/nxaa010

DO - 10.1093/jn/nxaa010

M3 - Article

C2 - 32006029

SN - 0022-3166

VL - 150

SP - 1160

EP - 1166

JO - Journal of Nutrition

JF - Journal of Nutrition

IS - 5

ER -