Effects of amino acid dialysis compared to dextrose dialysis in children on continuous cycling peritoneal dialysis

Objective:To compare the biochemical and nutritional effects of amino acid dialysis with dextrose dialysis in children receiving continuous cycling pe ritoneal dialysis (CCPD). Design: A prospective randomized cross-over study. Setting: Nonhospitalized patients. Patients: Seven children aged 1.8 to 16.0 years (mean 8.1 years) with end-s tage renal disease who were receiving CCPD. Interventions: Each patient received nighttime automated CCPD of dextrose, plus a single daytime dwell of either amino acid dialysate or dextrose dial ysate. After 3 months, subjects crossed over to the alternative regimen for a subsequent 3 months. Main Outcome Measures: Creatinine clearance, ultrafiltration, urea, creatin ine, electrolytes, total protein, albumin, fasting plasma amino acids, anth ropometrics, total body nitrogen. Results: Amino acid dialysis was comparable to dextrose dialysis for creati nine clearance and ultrafiltration. Plasma urea concentrations were higher during amino acid dialysis. No clinical side effects or worsening of metabo lic acidosis was observed. Caloric intake increased and protein intake impr oved. Appetite and total body nitrogen increased in at least half the child ren during amino acid dialysis. Total plasma protein and albumin concentrat ions did not change significantly. Fasting plasma concentrations of amino a cids after 3 months of amino acid dialysis were comparable to baseline valu es. For several amino acids, the dose-response curve was blunted after a si ngle amino acid exchange following 3 months of amino acid dialysis, which m ay, in part, be due to the induction of hepatic enzyme synthesis. Conclusions: Amino acid dialysis is an efficient form of peritoneal dialysi s that should be considered for children with poor nutritional status for w hom enteral nutrition supplementation has been unsuccessful. Further study is needed to determine the optimal amount of amino acids to deliver, the be st time to administer the amino acid dialysis fluid, and the benefits of ad ding dextrose to the amino acid solution.