Nephrology Dialysis Transplantation, Vol 14, Issue 1 154-159, Copyright © 1999 by Oxford University Press
H Brulez, C van Guldener, A Donker and P ter Wee
Background: The caloric load from glucose-based
peritoneal dialysis (PD) fluids contributes to hypertriglyceridaemia,
adiposity and, as result of anorexia, protein malnutrition in PD patients.
It has been suggested that replacement of a glucose-based by an amino
acids-based PD fluid (AA-PDF) for one exchange per day might improve the
nutritional status and lipid profile. Due to the uptake of methionine for
the dialysate, however, exposure to AA-PDF might aggravate
hyperhomocysteinaemia, a frequently occurring risk factor for
atherosclerosis in uraemic patients. Methods: We
studied the impact of a once daily exchange with 1.1% AA-PDF instead of
glucose-based PD fluid for 2 months on plasma methionine and total
homocysteine (tHcy) levels, lipid profile, butyrylcholinesterase (BChE) and
body fat mass of seven stable PD patients. Results are expressed as mean
±SEM. Results: Methionine levels did not
increase significantly during therapy, but tHcy levels increased
substantially from 60±12 to 84±19 &mgr;mol/l
after 1 month (P-0.039), and to 85±22 &mgr;mol/l after 2
months of AA-PDF treatment. Serum triglyceride concentration decreased from
3.0±0.4 mmol/l at entry to 2.6±0.5 mmol/l (at 1
month, P-0.041 vs baseline). Serum BChE also decreased
from 6.9±0.4 U/ml at entry to 6.3±0.4 U/ml after 2
months (P=0.014). Total cholesterol concentration and cholesterol fractions
did not change. The reduced exposure to glucose-based PD fluid for 2 months
results in a 0.5 kg reduction in fat mass which was due mainly to a
reduction in fat mass of the trunk region (0.3 kg, P-0.031).
Conclusions: It is concluded that
methionine-containing AA-PDF induces an increase in the plasma tHcy level.
This might, potentially, offset the beneficial effects of an improved serum
lipid profile and reduced fat mass on the risk of cardiovascular disease in
PD patients. Lowering the methionine content of the fluid, therefore, may
be required to overcome this adverse effect. Key
words: amino acids; atherosclerosis; hyperhomocysteinaemia;
hypertriglyceridaemia; peritoneal dialysis; von Willebrand factor
ORIGINAL ARTICLES
The impact of an amino acids-based peritoneal dialysis fluid on plasma total homocysteine levels, lipid profile and body fat mass
Department of Nephrology, Academisch Ziekenhuis Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Corresponding author
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