AMINO-ACID LOSSES AND NITROGEN-BALANCE DURING SLOW DIURNAL HEMODIALYSIS IN CRITICALLY ILL PATIENTS WITH RENAL-FAILURE

Objective: The effects of slow diurnal hemodialysis (slow HD) on amino acid losses and nitrogen balance were studied. Design. Slow HD was co nducted for 10 h during the day at the dialysate flow rate of 30 ml/mi n, The patients received total parenteral nutrition including 40 g of amino acids (6.08 g of nitrogen), The amino acid concentrations in pla sma and dialysate were determined and the daily nitrogen balance was c alculated from the urea nitrogen appearance. Patients: Six critically ill patients with renal failure were entered into the study. Results: Slow HD eliminated 48.5 +/- 4.4 mmol (6.2 +/- 0.6 g) of amino acids, r epresenting 16% of the daily amino acid load. The estimated nitrogen b alance was -2.3 +/- 1.3 g/day. Amino acid nitrogen lost in the dialysa te was 1.0 +/- 0.1 g, contributing 43% of the daily negative nitrogen balance, Conclusion: The amount of amino acid losses during slow HD sh ould be taken into consideration when designing nutritional schedules for maintaining positive nitrogen balance in critically ill patients.