Qamar I U, Levin L, Balfe J W, Balfe J A, Secker D, Zlotkin S
Division of Paediatric Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada.
Perit Dial Int. 1994;14(1):34-41.
To compare the nutritional and biochemical effects of amino acid dialysis to dextrose dialysis in children receiving continuous ambulatory peritoneal dialysis (CAPD).
Prospective randomized crossover study.
Pediatric Nephrology Unit in a tertiary care, teaching hospital of the University of Toronto.
Seven children aged 0.7-16.5 years receiving CAPD. All patients had poor linear growth, with 5 patients showing evidence of energy deficit.
Each patient received either amino acid or dextrose dialysate for 3 months, then crossed over to the alternate regimen for a subsequent 3 months.
Nutritional and biochemical data were obtained on each patient during each dialysis regimen.
Analysis of the patients' nutritional data showed comparable weight gain with both regimens but no significant improvement in lean body mass with either regimen. Appetite improved in most patients during amino acid dialysis. Biochemical data during amino acid dialysis showed a tendency to higher plasma potassium and urea levels with no clinical side effects or worsening of acidosis; however, there was a reduced anion gap and increased total plasma protein, due mostly to a rise in plasma albumin and a smaller increase in immunoglobulins. With the exception of tryptophan, fasting amino acid levels at the start and end of amino acid dialysis did not show any significant change. An interesting phenomenon of early blunting of the rise in amino acid levels, following a single amino acid dialysate exchange, was noticed at the end of the amino acid dialysis period. This newly described phenomenon could have been due to tolerance or hepatic enzyme induction.
Overall amino acid dialysis was comparable to dextrose dialysis with no additional proven nutritional benefit, was equally effective in ultrafiltration and creatinine clearance, and produced no adverse clinical or biochemical effects.
比较接受持续性非卧床腹膜透析（CAPD）的儿童使用氨基酸透析液与葡萄糖透析液的营养及生化效应。
前瞻性随机交叉研究。
多伦多大学一所三级护理教学医院的儿科肾脏病科。
7名接受CAPD治疗的0.7至16.5岁儿童。所有患者线性生长均较差，5名患者有能量缺乏的证据。
每位患者接受氨基酸或葡萄糖透析液治疗3个月，然后在接下来的3个月交叉使用另一种治疗方案。
在每种透析方案期间获取每位患者的营养和生化数据。
对患者营养数据的分析显示，两种方案的体重增加相当，但两种方案在瘦体重方面均无显著改善。大多数患者在氨基酸透析期间食欲改善。氨基酸透析期间的生化数据显示血浆钾和尿素水平有升高趋势，但无临床副作用或酸中毒加重；然而，阴离子间隙降低，血浆总蛋白增加，这主要是由于血浆白蛋白升高以及免疫球蛋白升高幅度较小。除色氨酸外，氨基酸透析开始和结束时的空腹氨基酸水平无显著变化。在氨基酸透析期结束时，观察到一个有趣的现象，即单次氨基酸透析液交换后氨基酸水平升高出现早期钝化。这种新描述的现象可能是由于耐受性或肝酶诱导。
总体而言，氨基酸透析与葡萄糖透析相当，未显示出额外的营养益处，在超滤和肌酐清除方面同样有效，且未产生不良临床或生化影响。
