Comparison of Amino Acid Loss Between Constant Amino Acid Plus Dextrose Infusion and Sequential Dextrose Followed by Amino Acid Infusion During Hemodialysis: A Randomized Crossover Trial
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Abstract
Background: Increasing amino acid loss has been observed in patients receiving intradialytic parenteral nutrition (IDPN). There are two standard protocols for lipid-free formula-IDPN infusion: constant amino acid plus dextrose infusion and sequential dextrose followed by amino acid infusion. However, the difference in amino acid loss between the two infusion protocols has never been explored.
Methods: The present study is a randomized crossover trial performed on ten malnourished chronic hemodialysis patients. They were randomized to receive a constant or sequential infusion protocol. The crossover was performed one week later. Plasma and dialysate amino acid concentrations were determined before and after the hemodialysis session. The changes in blood pressure and capillary glucose concentrations during hemodialysis were also recorded.
Results: The average declines in plasma essential, non-essential, and total amino acid concentrations were comparable between the two infusion protocols. Substantially higher non-essential and total amino acid concentrations were observed in the dialysate from the constant infusion group. In the sequential infusion group, the average capillary glucose level was higher at the 2nd hour and lower at the 4th hour of hemodialysis, and two patients had hypotension.
Conclusion: Constant infusion of amino acid plus dextrose solution during hemodialysis resulted in a more significant loss of amino acids into dialysate than the sequential infusion of dextrose followed by amino acids.
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