6-MONTH PROSPECTIVE CROSS-OVER STUDY TO DETERMINE THE EFFECTS OF 1.1-PERCENT AMINO-ACID DIALYSATE ON LIPID-METABOLISM IN PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Objective: To evaluate the effect of 1.1% amino acid dialysate (AAD) ( Nutrineal, Baxter, Castlebar, Ireland) on lipid metabolism in hyperlip idemic patients on continuous ambulatory peritoneal dialysis (CAPD). D esign: Patients were alternately assigned to receive AAD in the first (group A), or the second (group B), 6 months of a prospective cross-ov er study. Setting: University teaching hospital. Patients: Eighteen st able CAPD patients with a serum cholesterol 5.5 mmol/L or greater. Int erventions: One post prandial exchange of AAD during a 24-hour period for 6 months. Main outcome measures: A significant change in serum lip id levels. Results: Patients in group A (n = 10) received a single dai ly exchange of AAD in place of their post prandial dextrose exchange f or the first 6 months, and then crossed over to the dextrose phase. Pa tients in group B (n = 8) continued their usual dextrose dialysis for the first 6 months and then crossed over to receive AAD in the latter 6 months. Measurements of serum lipids and lipoproteins along with oth er biochemical parameters were made at regular intervals. Although a d ownward trend in mean serum total cholesterol was seen on AAD in group A, no significant change in total cholesterol, low-density lipoprotei n cholesterol, or high-density lipoprotein cholesterol was observed in any group. Mean serum triglycerides fell on AAD in both groups, but w ere not statistically significant. Serum lipoprotein(a) [Lp(a)] and ap olipoprotein B were elevated in both groups but did not change on AAD or with time. No change was observed in serum apoprotein A, levels. Se rum Lp(a) was not correlated to dialysate protein excretion. No change in mean serum albumin was observed, in either group, on AAD. KT/V ure a, total weekly creatinine clearance, net ultrafiltration, and dialysa te protein excretion remained unchanged on AAD. Conclusions: The use o f AAD, although clinically safe and without side effects, had no effec t on the dyslipidemia in our group of CAPD patients.