Mediators of Inflammation 
Volume 2007 (2007), Article ID 97272, 5 pages
doi:10.1155/2007/97272
Research Article

Peritoneal Protein Losses and Cytokine Generation in Automated Peritoneal Dialysis with Combined Amino Acids and Glucose Solutions

H. L. Tjiong,1 F. J. Zijlstra,2 T. Rietveld,1 J. L. Wattimena,1 J. G. M. Huijmans,3 G. R. Swart,1 and M. W. J. A. Fieren1

 1Department of Internal Medicine, Erasmus MC, Rotterdam 3015 CE, The Netherlands
2Department of Anaesthesiology, Erasmus MC, Rotterdam 3015 CE, The Netherlands
3Department of Clinical Genetics, Erasmus MC, Rotterdam 3015 CE, The Netherlands
Received 26 September 2007; Accepted 26 November 2007

Abstract

Objectives. Protein-energy malnutrition as a consequence of deficient protein intake frequently occurs in peritoneal dialysis (PD) patients. Previously, we showed that peritoneal dialysate containing a mixture of amino acids (AA) and glucose has anabolic effects. However AA-dialysate has been reported to increase intraperitoneal protein and AA losses and the release of proinflammatory cytokines (interleukine-6 (IL-6) and tumor necrosis factor alpha (TNFα)). We investigated the effect of AA plus glucose (AAG) solutions on peritoneal protein losses and cytokine generation. Methods. In 6 patients on standard automated peritoneal dialysis (APD) 12 APD sessions of 6 cycles each were performed during the night using dialysate containing 1.1% AA plus glucose or glucose alone as control. Protein losses and TNFα and IL-6 concentrations were measured in dialysates separately collected from nightly cycling and daytime dwell. Results. The 24 hour-protein losses with AAG (median 6.7 g, range 4.7–9.4 g) were similar to control dialysate (median 6.0 g, range 4.2–9.2 g). Daytime dialysate IL-6 levels were higher after nightly AAG dialysis than after control dialysis (142 pg/ml and 82 pg/ml, respectively, P<.05). TNFα concentrations were very low. Conclusion. Nightly APD with amino acids containing dialysate was associated with an increase in peritoneal IL-6 generation during the day. The addition of AA to standard glucose dialysis solutions did not induce a significant increase of peritoneal protein losses.