Department of Internal Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
Nutrients. 2022 Jul 8;14(14):2810. doi: 10.3390/nu14142810.
Patients dependent on chronic hemodialysis treatment are prone to malnutrition, at least in part due to insufficient nutrient intake, metabolic derangements, and chronic inflammation. Losses of amino acids during hemodialysis may be an important additional contributor. In this study, we assessed changes in plasma amino acid concentrations during hemodialysis, quantified intradialytic amino acid losses, and investigated whether plasma amino acid concentrations and amino acid losses by hemodialysis and urinary excretion are associated with fatigue. The study included a total of 59 hemodialysis patients (65 ± 15 years, 63% male) and 33 healthy kidney donors as controls (54 ± 10 years, 45% male). Total plasma essential amino acid concentration before hemodialysis was lower in hemodialysis patients compared with controls (p = 0.006), while total non-essential amino acid concentration did not differ. Daily amino acid losses were 4.0 ± 1.3 g/24 h for hemodialysis patients and 0.6 ± 0.3 g/24 h for controls. Expressed as proportion of protein intake, daily amino acid losses of hemodialysis patients were 6.7 ± 2.4% of the total protein intake, compared to 0.7 ± 0.3% for controls (p < 0.001). Multivariable regression analyses demonstrated that hemodialysis efficacy (Kt/V) was the primary determinant of amino acid losses (Std. β = 0.51; p < 0.001). In logistic regression analyses, higher plasma proline concentrations were associated with higher odds of severe fatigue (OR (95% CI) per SD increment: 3.0 (1.3; 9.3); p = 0.03), while higher taurine concentrations were associated with lower odds of severe fatigue (OR (95% CI) per log2 increment: 0.3 (0.1; 0.7); p = 0.01). Similarly, higher daily taurine losses were also associated with lower odds of severe fatigue (OR (95% CI) per log2 increment: 0.64 (0.42; 0.93); p = 0.03). Lastly, a higher protein intake was associated with lower odds of severe fatigue (OR (95% CI) per SD increment: 0.2 (0.04; 0.5); p = 0.007). Future studies are warranted to investigate the mechanisms underlying these associations and investigate the potential of taurine supplementation.
依赖慢性血液透析治疗的患者容易出现营养不良，至少部分原因是营养素摄入不足、代谢紊乱和慢性炎症。血液透析过程中氨基酸的损失可能是一个重要的额外贡献因素。在这项研究中，我们评估了血液透析过程中血浆氨基酸浓度的变化，量化了血液透析过程中的氨基酸损失，并研究了血浆氨基酸浓度和血液透析及尿排泄的氨基酸损失是否与疲劳有关。该研究共纳入 59 名血液透析患者（65 ± 15 岁，63%为男性）和 33 名健康肾脏供体作为对照（54 ± 10 岁，45%为男性）。与对照组相比，血液透析患者血液透析前的总血浆必需氨基酸浓度较低（p = 0.006），而非必需氨基酸浓度无差异。血液透析患者的每日氨基酸损失为 4.0 ± 1.3 g/24 h，而对照组为 0.6 ± 0.3 g/24 h。以蛋白质摄入量的比例表示，血液透析患者的每日氨基酸损失为总蛋白质摄入量的 6.7 ± 2.4%，而对照组为 0.7 ± 0.3%（p < 0.001）。多变量回归分析表明，血液透析效率（Kt/V）是氨基酸损失的主要决定因素（Std.β=0.51；p < 0.001）。在逻辑回归分析中，较高的血浆脯氨酸浓度与严重疲劳的可能性较高相关（SD 增量的 OR（95%CI）：3.0（1.3；9.3）；p = 0.03），而较高的牛磺酸浓度与严重疲劳的可能性较低相关（log2 增量的 OR（95%CI）：0.3（0.1；0.7）；p = 0.01）。同样，较高的每日牛磺酸损失也与严重疲劳的可能性较低相关（log2 增量的 OR（95%CI）：0.64（0.42；0.93）；p = 0.03）。最后，较高的蛋白质摄入量与严重疲劳的可能性较低相关（SD 增量的 OR（95%CI）：0.2（0.04；0.5）；p = 0.007）。未来的研究需要调查这些关联的潜在机制，并研究牛磺酸补充的潜力。
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