https://scholars.lib.ntu.edu.tw/handle/123456789/572048
標題: | Factors associated with increased plasma homocysteine in patients using an amino acid peritoneal dialysis fluid | 作者: | SHAO-YU YANG JENQ-WEN HUANG Shih K.-Y. Hsu S.-P. Chu P.-L. TZONG-SHINN CHU KWAN-DUN WU |
公開日期: | 2005 | 卷: | 20 | 期: | 1 | 起(迄)頁: | 161-166 | 來源出版物: | Nephrology Dialysis Transplantation | 摘要: | Background. Although amino acid peritoneal dialysate (AAPD) substitution is thought to improve protein-energy malnutrition in patients undergoing peritoneal dialysis (PD), it may also increase plasma homocysteine (Hcy) levels due to the methionine load in the dialysate. However, it is still unclear which factors are important for elevating Hcy in patients treated with AAPD. Methods. Sixteen malnourished PD patients (age 48±18 years) were treated daily with one exchange of 1.1% AAPD for 3 months. The effects of AAPD on nutrition, Hey, methionine, leptin and insulin resistance were studied. We also analysed factors that influenced plasma Hcy levels. Results. We found a transient increase in serum albumin (P<0.01) after 1 month treatment, especially in patients with serum albumin ≤ 3.5 g/dl. Total plasma Hcy increased markedly after AAPD (the peak at month 2, P<0.001) and returned to baseline after ceasing AAPD, despite no changes in dietary methionine intake and serum methionine levels. Eight patients with Hcy increments > 5.65 μM (the median) had lesser dietary intakes of protein (P=0.01) and methionine (P=0.028), lower body fat mass (P=0.05) and lower aspartate transaminase (AST) (P=0.008) before AAPD treatment than patients with lower increments. ΔHcy was inversely correlated with baseline dietary methionine intake (r=-0.61), protein intake (r=-0.54) and AST (r=-0.51) (all P<0.05). There was no change in leptin or insulin resistance. AAPD treatment significantly increased Kt/Vurea (P<0.001), weekly creatinine clearance (P<0.05) and peritoneal glucose transport (P<0.05). Conclusions. Treatment with 1.1% AAPD transiently increased serum albumin in malnourished PD patients. However, the methionine load from the dialysate in this study significantly elevated plasma Hcy levels, especially in patients with lower protein and methionine intakes, and lower AST levels. Further long-term studies will be needed to clarify potential nutritional benefits and adverse effects of AAPD. © ERA-EDTA 2004; all rights reserved. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-13444273613&doi=10.1093%2fndt%2fgfh554&partnerID=40&md5=ebe34ae1bf51add39b4c0714bec8bdd0 https://scholars.lib.ntu.edu.tw/handle/123456789/572048 |
ISSN: | 0931-0509 | DOI: | 10.1093/ndt/gfh554 | SDG/關鍵字: | albumin; aspartate aminotransferase; creatinine; folic acid; glucose; homocysteine; leptin; methionine; nutrineal; peritoneal dialysis fluid; urea; adult; aged; albumin blood level; amino acid blood level; amino acid substitution; appetite disorder; article; aspartate aminotransferase blood level; body fat; body mass; clinical article; concentration (parameters); concentration response; controlled study; correlation analysis; creatinine clearance; drug effect; female; glucose transport; hemodialysis patient; human; hyperhomocysteinemia; hypotension; insulin resistance; male; nausea; nutritional parameters; peritoneal dialysis; priority journal; protein calorie malnutrition; protein intake; risk benefit analysis; urea blood level; Adult; Amino Acids; Dialysis Solutions; Female; Follow-Up Studies; Homocysteine; Humans; Hyperhomocysteinemia; Kidney Failure, Chronic; Kidney Function Tests; Male; Malnutrition; Middle Aged; Peritoneal Dialysis; Probability; Prospective Studies; Risk Assessment; Severity of Illness Index; Single-Blind Method; Statistics, Nonparametric; Taiwan; Treatment Outcome |
顯示於: | 醫學教育暨生醫倫理學科所 |
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