1-PERCENT AMINO-ACID PERITONEAL DIALYSATE - SINGLE-CYCLE STUDY IN DIABETIC-PATIENTS WITH END-STAGE RENAL DISEASE

Uremia is associated with multiple abnormalities of carbohydrate and protein metabolism, which are partially corrected by continuous ambulatory peritoneal dialysis with dextrose-based solutions. The hormonal and metabolic effects of amino acid (AA)-based peritoneal dialysis have been studied in nondiabetic uremic patients. Such solutions may be particularly suitable for diabetic patients with end-stage renal disease provided the safety and efficacy of such solutions can be established. We have studied and compared the metabolic and hormonal responses to a single-cycle exchange of dextrose versus a 1 % AA-based continuous ambulatory peritoneal dialysis solution in six diabetic patients with end-stage renal disease. In the fasting state and under similar free insulin concentrations, use of the AA solution led to a higher mean glucose concentration (109 ± 16 mg/dL with dextrose solution v 128 ± 25 mg/dL with AA solution, P < 0.05). Levels of alanine, lactate, pyruvate, glycerol, non-esterified fatty acids, and triglycerides were similar with the use of either solution. Use of the AA-based solution led to increases in the mean values of the branched chain AAs for the period of the study (valine 131 ± 10 μmol/L with dextrose solution v 331 ± 40 μmol/L with AA solution, P < 0.01; leucine 72 ± 7 gmol/L with dextrose solution v 129 ± 11 μmol/L with AA solution, P < 0.01; isoleucine 48 + 5 μmol/L with dextrose solution v 103 ± 11 gmol/L with AA solution, P < 0.01). Thus, single-cycle studies of a 1 % AA-based peritoneal dialysis solution in diabetic patients showed no adverse effects when compared with a dextrose solution. Amino acid-based peritoneal dialysis solutions may be a suitable alternative to dextrose solutions for diabetic patients on continuous ambulatory peritoneal dialysis. © 1994, National Kidney Foundation. All rights reserved.. All rights reserved.