TREATMENT OF MALNUTRITION WITH 1.1-PERCENT AMINO-ACID PERITONEAL-DIALYSIS SOLUTION - RESULTS OF A MULTICENTER OUTPATIENT STUDY

A peritoneal dialysis (PD) solution containing 1.1% amino acids as the osmotic agent was evaluated in a 3-month randomized, prospective, ope n-label study in malnourished PD patients. Patients in the treatment g roup (DAA) received one or two exchanges daily with the amino acid sol ution, depending on tolerance, in place of glucose solutions. Controls (DD) received their usual therapy with glucose dialysate. Fifty-four DAA and 51 DD patients completed the study. In DAA, but not in DD pati ents, there was a significant increase at month 3 in serum insulin-lik e growth factor-1 (IGF-1) levels and significant decreases in serum po tassium (all 3 months) and inorganic phosphorus levels (months 1 and 3 ), indicating a general anabolic response. Prealbumin and transferrin levels were significantly increased in DAA but not in DD patients at m onth 1, but the groups did not differ at months 2 and 3. In patients w ith baseline albumin levels less than 3.5 g/dL (bromcresol green [BCG] method), DAA patients showed increases in albumin, transferrin (month s 1 and 2), and prealbumin levels (all 3 months) relative to baseline values, whereas these serum protein levels were unchanged in DD patien ts, although the changes from baseline did not differ between groups. In this subgroup, midarm muscle circumference (MAMC) did not change in DD or DAA patients. In patients with baseline albumin levels of 3.5 g /dL or greater, DD patients had decreases in albumin and total protein levels at all 3 months and in prealbumin levels at months 1 and 2, re lative to baseline. In DAA patients, there were fewer changes in serum proteins. MAMC increased significantly from baseline in DAA but not i n DD patients, although changes from baseline did not differ between D AA and Do groups. DAA patients showed no changes in peritoneal membran e transport characteristics. The results indicate that treatment with one or two exchanges daily of this amino acid-based PD solution is saf e and provides nutritional benefit for malnourished PD patients. (C) 1 998 by the National Kidney Foundation, Inc.