Amino-acid-based continuous ambulatory peritoneal dialysis (CAPD) fluid over twelve weeks: Effects on carbohydrate and lipid metabolism

Abstract

Aspects of lipid and carbohydrate metabolism were studied in 8 patients established on continuous ambulatory peritoneal dialysis (CAPD) with plasma albumin <35 g/L, before, during, and after substitution of 1 of the daily glucose exchangers by a commercial 1% amino acid dialysis fluid for 12 weeks. The amount of glucose absorbed from the dialysis fluid was consequently reduced by about 25%, hence total energy intake decreased by about 100 Kcal/day, but peritoneal glucose transfer kinetics were unaffected. Glucose was lost into amino acid dialysate as expected (2 g/day). Excluding 1 patient with a large rise in calorie intake, total and LDL cholesterol fell at 8 and 12 weeks (LDL cholesterol week 0, 5.26 ± 1.13; week 8, 4.32 ± 0.74; week 12, 4.30 ± 1.22; mean ± SD, p < 0.01 for both), but returned to baseline 2 weeks after the restoration of glucose fluid (LDL 4.91 ± 1.22, p < 0.05 vs. week 12). Apolipoprotein B concentration also fell at 12 weeks (p < 0.01). No changes were seen in body weight, body fat, arm muscle circumference, fasting plasma glucose, insulin, growth hormone, triglyceride, nonestrified fatty acids, or HDL cholesterol. The response of these biochemical indices to single 8-h glucose and amino aicd morning exchanges at 0 and 12 weeks were studied. After 12 week's use of amino acid dialysis fluid, plasma cholesterol and apolipoprotein B were significantly lower throughout the exchange. The decrease in cholesterol and apolipoprotein B during the substitution of 1% amino acid dialysis fluid may be associated not with the reduction in glucose intake, but also with a gradual change in lipid metabolism. The routine use of such solutions may lower cardiovascular morbidity and mortality in CAPD but further evaluation is indicated.