血液透析期间的氨基酸清除可通过蛋白质摄入得到补偿，且不会因透析期间的运动而受到影响：一项随机对照交叉试验。

Amino acid removal during hemodialysis can be compensated for by protein ingestion and is not compromised by intradialytic exercise: a randomized controlled crossover trial.

作者信息

Hendriks Floris K, Smeets Joey S J, van Kranenburg Janneau M X, Broers Natascha J H, van der Sande Frank M, Verdijk Lex B, Kooman Jeroen P, van Loon Luc J C

机构信息

Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.

Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.

出版信息

Am J Clin Nutr. 2021 Dec 1;114(6):2074-2083. doi: 10.1093/ajcn/nqab274.

DOI:10.1093/ajcn/nqab274

PMID:34510176

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8634611/

Abstract

BACKGROUND

Patients with end-stage renal disease (ESRD) undergoing hemodialysis experience a rapid decline in skeletal muscle mass and strength. Hemodialysis removes amino acids (AAs) from the circulation, thereby lowering plasma AA concentrations and stimulating proteolysis.

OBJECTIVES

In the present study, we evaluate the impact of intradialytic protein ingestion at rest and following exercise on AA removal and plasma AA availability in patients with ESRD.

METHODS

Ten patients (age: 65 ± 16 y, male/female: 8/2, BMI: 24.2 ± 4.8 kg/m2, serum albumin: 3.4 ± 0.3 g/dL) with ESRD undergoing hemodialysis participated in this randomized controlled crossover trial. During 4 hemodialysis sessions, patients were assigned to ingest 40 g protein or a placebo 60 min after initiation, both at rest (PRO and PLA, respectively) and following exercise (PRO + EX and PLA + EX, respectively). Spent dialysate and blood samples were collected every 30 min throughout hemodialysis to assess AA removal and plasma AA availability.

RESULTS

Plasma AA concentrations declined by 26.1 ± 4.5% within 30 min after hemodialysis initiation during all interventions (P < 0.001, η2p > 0.79). Protein ingestion, but not intradialytic exercise, increased AA removal throughout hemodialysis (9.8 ± 2.0, 10.2 ± 1.6, 16.7 ± 2.2, and 17.3 ± 2.3 g during PLA, PLA + EX, PRO, and PRO + EX interventions, respectively; protein effect P < 0.001, η2p = 0.97; exercise effect P = 0.32, η2p = 0.11). Protein ingestion increased plasma AA concentrations until the end of hemodialysis, whereas placebo ingestion resulted in decreased plasma AA concentrations (time effect P < 0.001, η2p > 0.84). Plasma AA availability (incremental AUC) was greater during PRO and PRO + EX interventions (49 ± 87 and 70 ± 34 mmol/L/240 min, respectively) compared with PLA and PLA + EX interventions (-227 ± 54 and -208 ± 68 mmol/L/240 min, respectively; protein effect P < 0.001, η2p = 0.98; exercise effect P = 0.21, η2p = 0.16).

CONCLUSIONS

Protein ingestion during hemodialysis compensates for AA removal and increases plasma AA availability both at rest and during recovery from intradialytic exercise. Intradialytic exercise does not compromise AA removal or reduce plasma AA availability during hemodialysis in a postabsorptive or postprandial state.

摘要

背景

接受血液透析的终末期肾病（ESRD）患者骨骼肌质量和力量迅速下降。血液透析会从循环中清除氨基酸（AA），从而降低血浆AA浓度并刺激蛋白水解。

目的

在本研究中，我们评估了静息及运动后透析期间摄入蛋白质对ESRD患者AA清除及血浆AA可用性的影响。

方法

10例接受血液透析的ESRD患者（年龄：65±16岁，男/女：8/2，体重指数：24.2±4.8kg/m²，血清白蛋白：3.4±0.3g/dL）参与了这项随机对照交叉试验。在4次血液透析过程中，患者被分配在透析开始60分钟后摄入40g蛋白质或安慰剂，分别在静息状态下（分别为PRO和PLA）以及运动后（分别为PRO+EX和PLA+EX）。在整个血液透析过程中，每30分钟收集用过的透析液和血样，以评估AA清除及血浆AA可用性。

结果

在所有干预措施中，血液透析开始后30分钟内血浆AA浓度下降了26.1±4.5%（P<0.001，η2p>0.79）。摄入蛋白质而非透析期间运动增加了整个血液透析过程中的AA清除（在PLA、PLA+EX、PRO和PRO+EX干预期间分别为9.8±2.0、10.2±1.6、16.7±2.2和17.3±2.3g；蛋白质效应P<0.001，η2p=0.97；运动效应P=0.32，η2p=0.11）。摄入蛋白质使血浆AA浓度在血液透析结束前一直升高，而摄入安慰剂则导致血浆AA浓度降低（时间效应P<0.001，η2p>0.84）。与PLA和PLA+EX干预相比（分别为-227±54和-208±68mmol/L/240分钟），PRO和PRO+EX干预期间的血浆AA可用性（增量曲线下面积）更高（分别为49±87和70±34mmol/L/240分钟；蛋白质效应P<0.001，η2p=0.98；运动效应P=0.21，η2p=0.16）。