Peritoneal Protein Losses and Cytokine Generation in Automated Peritoneal Dialysis with Combined 
Amino Acids and Glucose Solutions

Tjiong, H. L.; Zijlstra, F. J.; Rietveld, T.; Wattimena, J. L.; Huijmans, J. G. M.; Swart, G. R.; Fieren, M. W. J. A.

doi:https://doi.org/10.1155/2007/97272

Mediators of Inflammation

On this page

Abstract References Copyright Related Articles

Research Article | Open Access

Volume 2007 | Article ID 097272 | https://doi.org/10.1155/2007/97272

Peritoneal Protein Losses and Cytokine Generation in Automated Peritoneal Dialysis with Combined Amino Acids and Glucose Solutions

H. L. Tjiong,¹F. J. Zijlstra,²T. Rietveld,¹J. L. Wattimena,¹J. G. M. Huijmans,³G. R. Swart,¹and M. W. J. A. Fieren¹

Received26 Sept 2007

Accepted26 Nov 2007

Published17 Dec 2007

Abstract

Objectives. Protein-energy malnutrition as a consequence of deficient protein intake frequently occurs in peritoneal dialysis (PD) patients. Previously, we showed that peritoneal dialysate containing a mixture of amino acids (AA) and glucose has anabolic effects. However AA-dialysate has been reported to increase intraperitoneal protein and AA losses and the release of proinflammatory cytokines (interleukine-6 (IL-6) and tumor necrosis factor alpha (TNFα)). We investigated the effect of AA plus glucose (AAG) solutions on peritoneal protein losses and cytokine generation. Methods. In 6 patients on standard automated peritoneal dialysis (APD) 12 APD sessions of 6 cycles each were performed during the night using dialysate containing 1.1% AA plus glucose or glucose alone as control. Protein losses and TNFα and IL-6 concentrations were measured in dialysates separately collected from nightly cycling and daytime dwell. Results. The 24 hour-protein losses with AAG (median 6.7 g, range 4.7–9.4 g) were similar to control dialysate (median 6.0 g, range 4.2–9.2 g). Daytime dialysate IL-6 levels were higher after nightly AAG dialysis than after control dialysis (142 pg/ml and 82 pg/ml, respectively, P<.05). TNFα concentrations were very low. Conclusion. Nightly APD with amino acids containing dialysate was associated with an increase in peritoneal IL-6 generation during the day. The addition of AA to standard glucose dialysis solutions did not induce a significant increase of peritoneal protein losses.

References

J. D. Kopple, M. J. Blumenkrantz, M. R. Jones, J. K. Moran, and J. W. Coburn, “Plasma amino acid levels and amino acid losses during continuous ambulatory peritoneal dialysis,” American Journal of Clinical Nutrition, vol. 36, no. 3, pp. 395–402, 1982.
View at: Google Scholar
N. Dombros, A. Oren, E. B. Marliss et al., “Plasma amino acid profiles and amino acid losses in patients undergoing CADP,” Peritoneal Dialysis International, vol. 2, no. 1, pp. 27–32, 1982.
View at: Google Scholar
M. J. Blumenkrant, G. M. Gahl, J. D. Kopple et al., “Protein losses during peritoneal dialysis,” Kidney International, vol. 19, no. 4, pp. 593–602, 1981.
View at: Publisher Site | Google Scholar
J. T. Dulaney and F. E. Hatch Jr., “Peritoneal dialysis and loss of proteins: a review,” Kidney International, vol. 26, no. 3, pp. 253–262, 1984.
View at: Publisher Site | Google Scholar
R. P. Popovich, J. W. Moncrief, K. D. Nolph, A. J. Ghods, Z. J. Twardowski, and W. K. Pyle, “Continuous ambulatory peritoneal dialysis,” Annals of Internal Medicine, vol. 88, no. 4, pp. 449–456, 1978.
View at: Google Scholar
J. Rubin, K. D. Nolph, D. Arfania et al., “Protein losses in continuous ambulatory peritoneal dialysis,” Nephron, vol. 28, no. 5, pp. 218–221, 1981.
View at: Google Scholar
A. Katirtzoglou, D. G. Oreopoulos, H. Husdan, M. Leung, R. Ogilvie, and N. Dombros, “Reappraisal of protein losses in patients undergoing continuous ambulatory peritoneal dialysis,” Nephron, vol. 26, no. 5, pp. 230–233, 1980.
View at: Google Scholar
S. Gordon and M. E. Rubini, “Protein losses during peritoneal dialysis,” American Journal of the Medical Sciences, vol. 253, no. 3, pp. 283–292, 1967.
View at: Google Scholar
R. T. Krediet, F. M. J. Zuyderhoudt, E. W. Boeschoten, and L. Arisz, “Peritoneal permeability to proteins in diabetic and non-diabetic continuous ambulatory peritoneal dialysis patients,” Nephron, vol. 42, no. 2, pp. 133–140, 1986.
View at: Google Scholar
T. A. Ikizler, J. H. Greene, R. L. Wingard, R. A. Parker, and R. M. Hakim, “Spontaneous dietary protein intake during progression of chronic renal failure,” Journal of the American Society of Nephrology, vol. 6, no. 5, pp. 1386–1391, 1995.
View at: Google Scholar
H. L. Tjiong, J. W. van den Berg, J. L. Wattimena et al., “Dialysate as food: combined amino acid and glucose dialysate improves protein anabolism in renal failure patients on automated peritoneal dialysis,” Journal of the American Society of Nephrology, vol. 16, no. 5, pp. 1486–1493, 2005.
View at: Publisher Site | Google Scholar
H. B. Steinhauer, I. Lubrich-Birkner, R. Kluthe, G. Baumann, and P. Schollmeyer, “Effect of amino acid based dialysis solution on peritoneal permeability and prostanoid generation in patients undergoing continuous ambulatory peritoneal dialysis,” American Journal of Nephrology, vol. 12, no. 1-2, pp. 61–67, 1992.
View at: Google Scholar
J. Plum, A. Fussholler, G. Schoenicke et al., “In vivo and in vitro effects of amino-acid-based and bicarbonate-buffered peritoneal dialysis solutions with regard to peritoneal transport and cytokines/prostanoids dialysate concentrations,” Nephrology Dialysis Transplantation, vol. 12, no. 8, pp. 1652–1660, 1997.
View at: Publisher Site | Google Scholar
G. A. Young, J. B. Dibble, A. E. Taylor, S. Kendall, and A. M. Brownjohn, “A longitudinal study of the effects of amino acid-based CAPD fluid on amino acid retention and protein losses,” Nephrology Dialysis Transplantation, vol. 4, no. 10, pp. 900–905, 1989.
View at: Google Scholar
M. Jones, T. Hagen, C. A. Boyle, E. Vonesh et al., “Treatment of malnutrition with 1.1% Amino acid peritoneal dialysis solution: results of a multicenter outpatient study,” American Journal of Kidney Diseases, vol. 32, no. 5, pp. 761–769, 1998.
View at: Google Scholar
W. M. Westra, J. D. Kopple, R. T. Krediet, M. Appell, and R. Mehrotra, “Dietary protein requirements and dialysate protein losses in chronic peritoneal dialysis patients,” Peritoneal Dialysis International, vol. 27, no. 2, pp. 192–195, 2007.
View at: Google Scholar
K. D. Nolph, Z. J. Twardowski, R. P. Popovich, and J. Rubin, “Equilibration of peritoneal dialysis solutions during long-dwell exchanges,” Journal of Laboratory and Clinical Medicine, vol. 93, no. 2, pp. 246–256, 1979.
View at: Google Scholar
P. Kathuria, H. L. Moore, R. Khanna, Z. J. Twardowski, S. Goel, and K. D. Nolph, “Effect of dialysis modality and membrane transport characteristics on dialysate protein losses of patients on peritoneal dialysis,” Peritoneal Dialysis International, vol. 17, no. 5, pp. 449–454, 1997.
View at: Google Scholar
H. L. Tjiong, T. Rietveld, J. L. Wattimena et al., “Peritoneal dialysis with solutions containing amino acids plus glucose promotes protein synthesis during oral feeding,” Clinical Journal of the American Society of Nephrology, vol. 2, no. 1, pp. 74–80, 2007.
View at: Publisher Site | Google Scholar
C. E. Douma, D. R. de Waart, D. G. Struijk, and R. T. Krediet, “Effect of amino acid based dialysate on peritoneal blood flow and permeability in stable CAPD patients: a potential role for nitric oxide?” Clinical Nephrology, vol. 45, no. 5, pp. 295–302, 1996.
View at: Google Scholar
A. Olszowska, J. Waniewski, A. Werynski, B. Anderstam, B. Lindholm, and Z. Wankowicz, “Peritoneal transport in peritoneal dialysis patients using glucose-based and amino acid-based solutions,” Peritoneal Dialysis International, vol. 27, no. 5, pp. 544–553, 2007.
View at: Google Scholar
D. Zemel, R. J. M. ten Berge, D. G. Struijk, E. Bloemena, G. C. M. Koomen, and R. T. Krediet, “Interleukin-6 in CAPD patients without peritonitis: relationship to the intrinsic permeability of the peritoneal membrane,” Clinical Nephrology, vol. 37, no. 2, pp. 97–103, 1992.
View at: Google Scholar
M. Goldman, P. Vandenabeele, J. Moulart et al., “Intraperitoneal secretion of interleukin-6 during continuous ambulatory peritoneal dialysis,” Nephron, vol. 56, no. 3, pp. 277–280, 1990.
View at: Google Scholar
D. Zemel, A. L.T. Imholz, D. R. de Waart, C. Dinkla, D. G. Struijk, and R. T. Krediet, “Appearance of tumor necrosis factor- $α$ and soluble TNF-receptors I and II in peritoneal effluent of CAPD,” Kidney International, vol. 46, no. 5, pp. 1422–1430, 1994.
View at: Publisher Site | Google Scholar
T. A. Martikainen, A.-M. Teppo, C. Grönhagen-Riska, and A. V. Ekstrand, “Glucose-free dialysis solutions: inductors of inflammation or preservers of peritoneal membrane?” Peritoneal Dialysis International, vol. 25, no. 5, pp. 453–460, 2005.
View at: Google Scholar
N. Topley, A. Jorres, W. Luttmann et al., “Human peritoneal mesothelial cells synthesize interleukin-6: induction by IL-1 $ß$ and TNF $a$ ,” Kidney International, vol. 43, no. 1, pp. 226–233, 1993.
View at: Publisher Site | Google Scholar
M. W. J. A. Fieren, G. J. C. M. van den Bemd, and I. L. Bonta, “Endotoxin-stimulated peritoneal macrophages obtained from continuous ambulatory peritoneal dialysis patients show an increased capacity to release interleukin-1 $β$ in vitro during infectious peritonitis,” European Journal of Clinical Investigation, vol. 20, no. 4, pp. 453–457, 1990.
View at: Google Scholar
W. M. Pruimboom, D. J. Bac, A. P. M. van Dijk et al., “Levels of soluble intercellular adhesion molecule 1, eicosanoids and cytokines in ascites of patients with liver cirrhosis, peritoneal cancer and spontaneous bacterial peritonitis,” International Journal of Immunopharmacology, vol. 17, no. 5, pp. 375–384, 1995.
View at: Publisher Site | Google Scholar

Copyright

Copyright © 2007 H. L. Tjiong et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation Order printed copies

Views

306

Downloads

791

Citations