Amino-acid-based peritoneal dialysis solution improves amino-acid transport into skeletal muscle

摘要

Abnormalities of amino-acid (AA) and protein metabolism are known to occur in chronic kidney disease (CKD). Protein malnutrition may contribute to impaired prognosis of dialysis patients. A crucial step in protein metabolism is AA transport into the cells. We compared the effects of an AA-containing peritoneal dialysis (PD) solution to glucose-based solutions on skeletal muscle AA uptake. Thirteen nondiabetic PD patients were studied twice in a random order and in a crossover manner both in the fasting state and during euglycemic insulin stimulation using [11C]methylaminoisobutyrate ([11C]MeAIB) and positron emission tomography (PET). Before both PET study days, patients had been using either glucose-based PD solutions only or one daily bag of AA solution in addition to glucose-based PD solutions for at least 6 weeks. Skeletal muscle AA uptake was calculated with graphical analysis. AA-containing PD solution increased plasma AA concentrations from 2.180.34 to 3.080.55mmoll-1 in the fasting state (P=0.0002) and from 1.880.15 to 2.420.30mmoll-1 during insulin stimulation (P-1min-1, respectively, P=0.0057) and during insulin stimulation (16.84.5 vs 21.14.9molkg-1min-1, respectively, P=0.0046). In conclusion, PD treatment with an AA-containing PD solution is associated with a significant increase in skeletal muscle AA uptake both in the fasting state and during insulin stimulation.