Acute effect of amino acid peritoneal dialysis solution on vascular function.

Abstract

BACKGROUND:

Oral ingestion of proteins or amino acids is associated with endothelial dysfunction. The effect of commercial amino acid peritoneal dialysis solutions on vascular function is unknown.

OBJECTIVE:

We compared the acute effect of intraperitoneal amino acid administration with that of intraperitoneal glucose administration on vascular function in peritoneal dialysis patients.

DESIGN:

In an open-label randomized, controlled, crossover and observer-blinded trial, we examined the acute effect of an intraperitoneal application of 2 L commercial 1.1% amino acid solution compared with that of a 2.27% glucose solution in 13 peritoneal dialysis patients. The primary endpoint was the change in forearm reactive hyperemia 6 h after instillation of either dialysis solution.

RESULTS:

After 6 h of dwell time, reactive hyperemia was substantially impaired after administration of the amino acid solution compared with the glucose solution (median difference: 202%; 95% CI: 57%, 368%; P = 0.007). In a comparison of differences between values at 6 h and those before treatment, reactive hyperemia significantly decreased during the dwell with the amino acid dialysis solution compared with that with the glucose dialysis solution (median difference: 242%; 95% CI: 53%, -457%; P = 0.013). In an analysis of smoking and nonsmoking patients separately, the difference in forearm blood flow between the 2 treatments was still statistically significant.

CONCLUSIONS:

One 6-h dwell with a commercial amino acid dialysis solution acutely impairs forearm reactive hyperemia in smoking and nonsmoking peritoneal dialysis patients. Because endothelial dysfunction is associated with increased morbidity and mortality, the long-term use of these solutions may increase the risk of cardiovascular disease.

• Authors: Andreas Vychytil, Manuela Födinger, Johannes Pleiner, Marcus Müllner, Peter Konner, Sonja Skoupy, Claudia Röhrer, Michael Wolzt, Gere Sunder-Plassmann
• Journal: The American journal of clinical nutrition (Am J Clin Nutr) Vol. 78 Issue 5 Pg. 1039-45 (Nov 2003) ISSN: 0002-9165 [Print] United States
• PMID: 14594793 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Amino Acids
• Solutions
• Homocysteine
• Nitroglycerin
• Glucose

Topics

• Adult
• Amino Acids (administration & dosage, adverse effects)
• Blood Flow Velocity (drug effects)
• Blood Pressure
• Cross-Over Studies
• Endothelium, Vascular (drug effects, physiopathology)
• Forearm (blood supply)
• Glucose (administration & dosage)
• Homocysteine (blood)
• Humans
• Hyperemia (chemically induced)
• Kidney Failure, Chronic (physiopathology, therapy)
• Middle Aged
• Nitroglycerin (administration & dosage)
• Peritoneal Dialysis (adverse effects)
• Plethysmography
• Solutions
• Vascular Diseases (chemically induced)