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Am J Physiol Endocrinol Metab (January 21, 2003). doi:10.1152/ajpendo.00264.2002
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Submitted on June 13, 2002
Accepted on January 15, 2003

PROTEIN INTAKE DURING HEMODIALYSIS MAINTAINS A POSITIVE WHOLE BODY PROTEIN BALANCE IN CHRONIC HEMODIALSYIS PATIENTS

Jorden M. Veeneman1, Hermi A. Kingma2, Theo Boer2, Frans Stellaard3, Paul E. de Jong1, Dirk-Jan Reijngoud3, and Roel M. Huisman1*

1 Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands; Groningen University Institute of Drug Exploration, Groningen, The Netherlands
2 Department of Pediatrics, University Hospital Groningen, Groningen, The Netherlands
3 Department of Pediatrics, University Hospital Groningen, Groningen, The Netherlands; Groningen University Institute of Drug Exploration, Groningen, The Netherlands

* To whom correspondence should be addressed. E-mail: R.M.HUISMAN{at}INT.AZG.NL.

Protein-energy malnutrition is present in 18 to 56 % of hemodialysis patients. Since 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 6 small test meals. Patients were also studied during two separate dialysis sessions (HD+ protocol). Patients were fasted during one session 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 into 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 to whole body protein synthesis and inversely correlated to 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 due to the increased amino acid concentrations in blood.




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