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NDT Advance Access published online on November 30, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh554
© 2004 by European Renal Association - European Dialysis and Transplant Association
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Received January 26, 2004
Accepted August 10, 2004

Original Articles

Factors associated with increased plasma homocysteine in patients using an amino acid peritoneal dialysis fluid

Shao-Yu Yang 1, Jenq-Wen Huang 2, Kai-Yao Shih 2, Shih-Ping Hsu 3, Pei-Lun Chu 2, Tzong-Shinn Chu 2, and Kwan-Dun Wu 2*

1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
3 Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan

* To whom correspondence should be addressed.
Kwan-Dun Wu, E-mail: kdw{at}ntumc.org.tw



  Abstract

Background. Although amino acid peritoneal dialysate (AAPD) substitution is thought to improve protein-energy malnutrition in patients undergoing peritoneal dialysis (PD), it may also increase plasma homocysteine (Hcy) levels due to the methionine load in the dialysate. However, it is still unclear which factors are important for elevating Hcy in patients treated with AAPD.

Methods. Sixteen malnourished PD patients (age 48±18 years) were treated daily with one exchange of 1.1% AAPD for 3 months. The effects of AAPD on nutrition, Hcy, methionine, leptin and insulin resistance were studied. We also analysed factors that influenced plasma Hcy levels.

Results. We found a transient increase in serum albumin (P<0.01) after 1 month treatment, especially in patients with serum albumin ≤ 3.5 g/dl. Total plasma Hcy increased markedly after AAPD (the peak at month 2, P<0.001) and returned to baseline after ceasing AAPD, despite no changes in dietary methionine intake and serum methionine levels. Eight patients with Hcy increments >5.65 µM (the median) had lesser dietary intakes of protein (P = 0.01) and methionine (P = 0.028), lower body fat mass (P = 0.05) and lower aspartate transaminase (AST) (P = 0.008) before AAPD treatment than patients with lower increments. {Delta}Hcy was inversely correlated with baseline dietary methionine intake (r = - 0.61), protein intake (r = - 0.54) and AST (r = - 0.51) (all P<0.05). There was no change in leptin or insulin resistance. AAPD treatment significantly increased Kt/Vurea (P<0.001), weekly creatinine clearance (P<0.05) and peritoneal glucose transport (P<0.05).

Conclusions. Treatment with 1.1% AAPD transiently increased serum albumin in malnourished PD patients. However, the methionine load from the dialysate in this study significantly elevated plasma Hcy levels, especially in patients with lower protein and methionine intakes, and lower AST levels. Further long-term studies will be needed to clarify potential nutritional benefits and adverse effects of AAPD.

Keywords: amino acid peritoneal dialysate; homocysteine; nutrition; peritoneal dialysis.
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