High protein intake during continuous hemodiafiltration: Impact on amino acids and nitrogen balance

Rinaldo Bellomo, H. K. Tan, S. Bhonagiri, I. Gopal, J. Seacombe, M. Daskalakis, N. Boyce

Research output: Contribution to journalArticleResearchpeer-review

73 Citations (Scopus)

Abstract

Aims: To study the effect of combined continuous veno-venous hemodiafiltration (CVVHDF) and high (2.5 g/kg/day) parenteral amino acid supplementation on nitrogen balance, amino acid losses and azotemic control in a cohort of patients with severe acute renal failure (ARF). Methods: We administered 2.5 grams/kg/day of amino acids intravenously to seven critically ill patients with ARF. We obtained paired blood and ultrafiltrate (UF) samples (n=20) and calculated amino acid clearances and losses, nitrogen balance, protein catabolic rate and total nitrogen losses. Results: The median total serum amino acid concentration was high at 5.2 mmol/L with particularly high concentrations of ornithine, lysine, and phenylalanine, but a low level of histidine. The median overall amino acid clearance was 18.6 ml/min (range: 12 to 29 ml/min). UF losses as percentage of administered dose were high for tyrosine (53.6%) but low for methionine (3.0%) and arginine (2.3%). A positive nitrogen balance was achieved in 7 (35%) of the 20 study days with an overall median nitrogen balance of -1.8 g/day. Urea levels were maintained at a median of 26.6 mmol/L. Conclusions: High protein intake increases the serum concentrations of most amino acids. Such protein supplementation, when coupled with CVVHDF, achieves a slightly negative overall nitrogen balance in extremely catabolic patients while still allowing adequate azotemic control.

Original languageEnglish
Pages (from-to)261-268
Number of pages8
JournalInternational Journal of Artificial Organs
Volume25
Issue number4
Publication statusPublished - 1 Jan 2002
Externally publishedYes

Keywords

  • Acute renal failure
  • Amino acids
  • Critical illness
  • Hemofiltration
  • Parenteral nutrition
  • Uremia

Cite this

Bellomo, R., Tan, H. K., Bhonagiri, S., Gopal, I., Seacombe, J., Daskalakis, M., & Boyce, N. (2002). High protein intake during continuous hemodiafiltration: Impact on amino acids and nitrogen balance. International Journal of Artificial Organs, 25(4), 261-268.
Bellomo, Rinaldo ; Tan, H. K. ; Bhonagiri, S. ; Gopal, I. ; Seacombe, J. ; Daskalakis, M. ; Boyce, N. / High protein intake during continuous hemodiafiltration : Impact on amino acids and nitrogen balance. In: International Journal of Artificial Organs. 2002 ; Vol. 25, No. 4. pp. 261-268.
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Bellomo, R, Tan, HK, Bhonagiri, S, Gopal, I, Seacombe, J, Daskalakis, M & Boyce, N 2002, 'High protein intake during continuous hemodiafiltration: Impact on amino acids and nitrogen balance', International Journal of Artificial Organs, vol. 25, no. 4, pp. 261-268.

High protein intake during continuous hemodiafiltration : Impact on amino acids and nitrogen balance. / Bellomo, Rinaldo; Tan, H. K.; Bhonagiri, S.; Gopal, I.; Seacombe, J.; Daskalakis, M.; Boyce, N.

In: International Journal of Artificial Organs, Vol. 25, No. 4, 01.01.2002, p. 261-268.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - High protein intake during continuous hemodiafiltration

T2 - Impact on amino acids and nitrogen balance

AU - Bellomo, Rinaldo

AU - Tan, H. K.

AU - Bhonagiri, S.

AU - Gopal, I.

AU - Seacombe, J.

AU - Daskalakis, M.

AU - Boyce, N.

PY - 2002/1/1

Y1 - 2002/1/1

N2 - Aims: To study the effect of combined continuous veno-venous hemodiafiltration (CVVHDF) and high (2.5 g/kg/day) parenteral amino acid supplementation on nitrogen balance, amino acid losses and azotemic control in a cohort of patients with severe acute renal failure (ARF). Methods: We administered 2.5 grams/kg/day of amino acids intravenously to seven critically ill patients with ARF. We obtained paired blood and ultrafiltrate (UF) samples (n=20) and calculated amino acid clearances and losses, nitrogen balance, protein catabolic rate and total nitrogen losses. Results: The median total serum amino acid concentration was high at 5.2 mmol/L with particularly high concentrations of ornithine, lysine, and phenylalanine, but a low level of histidine. The median overall amino acid clearance was 18.6 ml/min (range: 12 to 29 ml/min). UF losses as percentage of administered dose were high for tyrosine (53.6%) but low for methionine (3.0%) and arginine (2.3%). A positive nitrogen balance was achieved in 7 (35%) of the 20 study days with an overall median nitrogen balance of -1.8 g/day. Urea levels were maintained at a median of 26.6 mmol/L. Conclusions: High protein intake increases the serum concentrations of most amino acids. Such protein supplementation, when coupled with CVVHDF, achieves a slightly negative overall nitrogen balance in extremely catabolic patients while still allowing adequate azotemic control.

AB - Aims: To study the effect of combined continuous veno-venous hemodiafiltration (CVVHDF) and high (2.5 g/kg/day) parenteral amino acid supplementation on nitrogen balance, amino acid losses and azotemic control in a cohort of patients with severe acute renal failure (ARF). Methods: We administered 2.5 grams/kg/day of amino acids intravenously to seven critically ill patients with ARF. We obtained paired blood and ultrafiltrate (UF) samples (n=20) and calculated amino acid clearances and losses, nitrogen balance, protein catabolic rate and total nitrogen losses. Results: The median total serum amino acid concentration was high at 5.2 mmol/L with particularly high concentrations of ornithine, lysine, and phenylalanine, but a low level of histidine. The median overall amino acid clearance was 18.6 ml/min (range: 12 to 29 ml/min). UF losses as percentage of administered dose were high for tyrosine (53.6%) but low for methionine (3.0%) and arginine (2.3%). A positive nitrogen balance was achieved in 7 (35%) of the 20 study days with an overall median nitrogen balance of -1.8 g/day. Urea levels were maintained at a median of 26.6 mmol/L. Conclusions: High protein intake increases the serum concentrations of most amino acids. Such protein supplementation, when coupled with CVVHDF, achieves a slightly negative overall nitrogen balance in extremely catabolic patients while still allowing adequate azotemic control.

KW - Acute renal failure

KW - Amino acids

KW - Critical illness

KW - Hemofiltration

KW - Parenteral nutrition

KW - Uremia

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AN - SCOPUS:0036016008

VL - 25

SP - 261

EP - 268

JO - International Journal of Artificial Organs

JF - International Journal of Artificial Organs

SN - 0391-3988

IS - 4

ER -