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1 Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
2 Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biochemistry, Vanderbilt University Medical Center, Nashville, TN, USA
3 Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
* To whom correspondence should be addressed. E-mail: alp.ikizler{at}vanderbilt.edu.
Decreased dietary protein intake and hemodialysis (HD)-associated protein catabolism are among several factors that predispose chronic hemodialysis (CHD) patients to uremic malnutrition and associated muscle wasting. Intra-dialytic parenteral nutrition (IDPN) acutely reverses the net negative whole-body and forearm muscle protein balances observed during the HD procedure. Exercise has been shown to improve muscle protein homeostasis, especially if performed with adequately available intramuscular amino acids. We hypothesized that exercise performance would provide additive anabolic effects to the beneficial effects of IDPN. We studied six CHD patients at two separate HD sessions: 1) IDPN administration only and 2) IDPN + exercise. Patients were studied 2 hours before, during, and 2 hours following a HD session, using a primed-constant infusion of L- (1-13C) leucine and L- (ring-2H5) phenylalanine. Exercise combined with IDPN promoted additive 2-fold increases in forearm muscle essential amino acid uptake (455 ± 105 nmol/100ml/min vs. 229 ± 38 nmol/100ml/min, P<0.05) and net muscle protein accretion (125 ± 37 µg/100ml/min vs. 56 ± 30 µg/100ml/min, P<0.05) during HD when compared to IDPN alone. Measurements of whole-body protein homeostasis and energy expenditure were not altered by exercise treatment. In conclusion, exercise in the presence of adequate nutritional supplementation has potential as a therapeutic intervention to blunt the loss of muscle mass in CHD patients.
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