Amino Acid-Containing Peritoneal Dialysis Solution Administration in Malnourished Patients: Comparison between Daytime and Overnight Use

Objective. To compare the effects of daytime and overnight administration of a 1.1% amino acid-containing dialysate (AAD) (Nutrineal® PD 1.1%) on malnourished, peritoneal dialysis (PD) patients. Methods. Eighteen patients (mean age, 30.3 ± 16.2 yr) who had been undergoing continuous ambulatory PD for more than 6 months were enrolled in this study. They all had a serum albumin level < 4.0 g/dl and/or a normalized protein nitrogen appearance (nPNA) <1.0 g/kg/d. Patients were randomized into two groups-a daytime (D) and overnight (O) group-to receive one exchange of 1.1% AAD daily in place of 1.5% dextrose dialysate. Administration of AAD was stopped after 3 months. Laboratory values and nutritional status were followed up for an additional 3 months. Results. A total of 15 patients (7 in the D group and 8 in the O group) completed the study. Compared to baseline, the nPNA and serum albumin level of all 15 patients rose significantly following the 3 months of therapy (nPNA = 1.06 ± 0.26 vs. 1.18 ± 0.26 g/kg/d, p<0.05; albumin = 3.59 ± 0.41 vs. 3.82 ± 0.36 g/dl, p < 0.05). The venous bicarbonate level was lowered with use of the AAD (27.7 ± 2.2 mmol/L at baseline vs. 25.0 ± 3.2 mmol/L at month 3, p<0.05). However, the nPNA, venous bicarbonate, and albumin returned to near-baseline levels 3 months after termination of the AAD treatment. The serum BUN was significantly higher at month 3 and month 6 compared with baseline (baseline = 53.6 ± 20.8 mg/dl, month 3 = 73.1 ± 23.6 mg/dl, month 6 = 65. ± 21.8 mg/dl). We found a significant increase in serum albumin level and nPNA in the D group, but not in the O group, indicating that nutritional benefits were achieved in the D group. Our patients showed no changes in peritoneal membrane transport characteristics or in clearance. Conclusions. Treatment with this amino acid-based PD solution over a 3-month period provides nutritional benefit for the young-aged, non-diabetic, and malnourished PD patients. In addition, the improvement was more prominent when used during the daytime vs. the nighttime.