EFFECTS OF 3-MONTH AMINO-ACID DIALYSIS COMPARED TO DEXTROSE DIALYSIS IN CHILDREN ON CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Objectives: To compare the nutritional and biochemical effects of amin o acid dialysis to dextrose dialysis in children receiving continuous ambulatory peritoneal dialysis (CAPD). Design: Prospective randomized crossover study. Setting: Pediatric Nephrology Unit in a tertiary care , teaching hospital of the University of Toronto. Patients: Seven chil dren aged 0.7-16.5 years receiving CAPD. All patients had poor linear growth, with 5 patients showing evidence of energy deficit. Interventi ons: Each patient received either amino acid or dextrose dialysate for 3 months, then crossed over to the alternate regimen for a subsequent 3 months. Main Outcome Measures: Nutritional and biochemical data wer e obtained on each patient during each dialysis regimen. Results: Anal ysis of the patients, nutritional data showed comparable weight gain w ith both regimens but no significant improvement in lean body mass wit h either regimen. Appetite improved in most patients during amino acid dialysis. Biochemical data during amino acid dialysis showed a tenden cy to higher plasma potassium and urea levels with no clinical side ef fects or worsening of acidosis; however, there was a reduced anion gap and increased total plasma protein, due mostly to a rise in plasma al bumin and a smaller increase in immunoglobulins. With the exception of tryptophan, fasting amino acid levels at the start and end of amino a cid dialysis did not show any significant change. An interesting pheno menon of early blunting of the rise in amino acid levels, following a single amino acid dialysate exchange, was noticed at the end of the am ino acid dialysis period. This newly described phenomenon could have b een due to tolerance or hepatic enzyme induction. Conclusions: Overall amino acid dialysis was comparable to dextrose dialysis with no addit ional proven nutritional benefit, was equally effective in ultrafiltra tion and creatinine clearance, and produced no adverse clinical or bio chemical effects.