Protein metabolism in chronic renal failure

Abstract

In summary, when acidosis is corrected, uremia, per se, is not protein catabolic. Peritoneal dialysis is catabolic due to protein and amino acid loss. The hemodialysis procedure is also catabolic because of amino acid loss and a reduction in whole-body protein synthesis. Whether the hemodialysis procedure additionally induces proteolysis is not universally agreed. While whole-body amino acid flux showed only minimal increase in protein breakdown, local forearm muscle kinetics, on the other hand, showed markedly exaggerated proteolysis during the procedure. The reason for such discrepancy between whole-body and forearm kinetics is not obvious. Maintenance hemodialysis collectively can result in protein anabolism. Based on the data cited in this review, we recommend that a dietary protein intake of 0.8 g/kg/day is appropriate for the pre-dialysis population; and intake of 0.9-1.0 g/kg/day and 1.0-1.1 g/kg/day for maintenance hemodialysis and peritoneal dialysis patients, respectively, should be adequate (8). The energy intake should be 30-35 Kcal/kg/day depending on the age and the activity of the patient. © Wichtig Editore, 2004.