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

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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 languageEnglish
Pages (from-to)1160-1166
Number of pages7
JournalJournal of Nutrition
Volume150
Issue number5
DOIs
Publication statusPublished - 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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