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Am J Physiol Endocrinol Metab 284: E954-E965, 2003. First published January 21, 2003; doi:10.1152/ajpendo.00264.2002
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Vol. 284, Issue 5, E954-E965, May 2003

Protein intake during hemodialysis maintains a positive whole body protein balance in chronic hemodialysis patients

Jorden M. Veeneman1,2, Hermi A. Kingma3, Theo S. Boer3, Frans Stellaard2,3, Paul E. De Jong1,2, Dirk-Jan Reijngoud2,3, and Roel M. Huisman1,2

Division of Nephrology, Departments of 1 Internal Medicine and 3 Pediatrics, University Hospital Groningen and 2 Groningen University Institute of Drug Exploration, 9713 GZ Groningen, The Netherlands

Protein energy malnutrition is present in 18 to 56% of hemodialysis patients. Because hemodialysis has been regarded as a catabolic event, we studied whether consumption of a protein- and energy-enriched meal improves the whole body protein balance during dialysis in chronic hemodialysis (CHD) patients. Patients were studied on a single day between dialysis (HD- protocol) in the morning while fasting and in the afternoon while consuming six small test meals. Patients were also studied during two separate dialysis sessions (HD+ protocol). Patients were fasted during one and consumed the meals during the other. Whole body protein metabolism was studied by primed constant infusion of L-[1-13C]valine. During HD-, feeding changed the negative whole body protein balance observed during fasting to a positive protein balance. Dialysis deepened the negative balance during fasting, whereas feeding during dialysis induced a positive balance comparable to the HD- protocol while feeding. Plasma valine concentrations during the studies were correlated with whole body protein synthesis and inversely correlated with whole body protein breakdown. We conclude that the consumption of a protein- and energy-enriched meal by CHD patients while dialyzing can strongly improve whole body protein balance, probably because of the increased amino acid concentrations in blood.

protein turnover; stable isotope; valine


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