Amino acid losses during sustained lowefficiency dialysis in critically ill patients with acute kidney injury

Afia Umber, Martin J. Wolley, Thomas A. Golper, Mary J. Shaver, Mark R. Marshall

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Objective: Sustained lowefficiency dialysis (SLED) involves the use of standard dialysis machines for prolonged intermittent renal replacement therapy in critically ill patients. In this study we aimed to quantify dialysate amino acid (AA) and albumin losses in 5 patients who underwent successful SLED treatment. Design: This was a prospective observational study. Setting: The study was performed in a general intensive care unit. Subjects: The study was performed in critically ill patients with acute kidney injury undergoing SLED using low-flux hemodialyzers. Intervention: We performed total dialysate collection and measured dialysate AA profiles by reversephase high-pressure liquid chromatography using an automated AA analyser. Main outcome measure: Individual and total amino acid losses. Results: Albumin was undetectable in dialysate. The median (mean ± SD) total amino acid loss was 15.7 (23.4 ± 19.2) g/treatment, or 122.1 (180.6 ± 148.5) mmol/ treatment. Two patients were receiving intravenous nutrition. One patient had severe hepatic failure with encephalopathy, and had high dialysate AA levels with a total loss of 57 g/treatment. Conclusions: During SLED with low-flux hemodialyzers, albumin losses are negligible but AA losses to dialysate are comparable to those during continuous renal replacement therapy. Patients' nutritional protein prescriptions should be augmented to account for this.

Original languageEnglish (US)
Pages (from-to)93-99
Number of pages7
JournalClinical Nephrology
Volume81
Issue number2
DOIs
StatePublished - Feb 1 2014

Keywords

  • Acute kidney injury
  • Amino acids
  • Hemodialysis
  • Nutrition
  • Prolonged intermittent renal replacement therapy
  • Sustained low efficiency dialysis

ASJC Scopus subject areas

  • Nephrology

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