Plasma levels of branched chain amino acids in patients on regular hemodialysis before and after including a high-protein supplement in their diet.

Chronic renal failure (CRF) patients on hemodialysis have low plasma level of the branched chain amino acids (BCAA) leucine, isoleucine, and valine. The abnormalities in the plasma amino acid pool can be corrected with appropriate high-protein supplements. The present study was designed to evaluate the effect of a balanced protein nutritional supplement on the plasma level of BCAA. Twenty eight CRF patients who received hemodialysis treatment three times in a week were enrolled in the trial. The initial plasma levels of BCAA were as follows--leucine 15.46 +/- 3.88 mcg/ml, isoleucine 9.08 +/- 1.97 mcg/ml, and valine 24.05 +/- 5.06 mcg/ml. For a period of 6 months the patients received a balanced nutritional supplement (58-59% total protein content, leucine--8.6, isoleucine--4.8, and valine--5.7 g/100 g protein) on the day of hemodialysis at a dose 1.0 g/kg body weight. Three months after beginning of supplementation the plasma level of BCAA was found to be elevated--leucine by 36% (P < 0.001), valine by 30% (P < 0.001), and isoleucine by 27% (P < 0.001). The body mass index of the patients was also above the initial values. The plasma BCAA levels were maintained high until the sixth month from the beginning of trial and even a month after withdrawal of the supplement. The results obtained allow us to recommend inclusion of protein supplements with balanced amino acid content in the diet of these patients.