The Long-term Nutritional Effects of Amino-Acid Based Dialysis Solution (IPAA) in Malnourished CAPD Patients : Comparison of Responders and Non-responders

Choi, So Rae; Song, Yong Soo; Yoon, Soo Young; Yun, Do Sik; Ahn, Soo Hyun; Park, Hyung Cheon; Lee, Jong Ho; Kang, Shin Wook; Choi, Kyu Hun; Ha, Seong Kyu; Lee, Ho Yung; Han, Dae Suk

Abstract

BACKGROUND: IPAA provide nutritional benefit, at least in the short term. However, the long-term efficacy of IPAA in PD patients remains unclear. An attempt was made to evaluate long-term efficacy of IPAA and to ascertain possible factors associated with improved nutritional status after IPAA.
METHODS
The 46 malnourished CAPD patients were treated with IPAA (one exchange of Nutrineal daily) for one year. Various nutritional, boichemical variables, urea kinetic study and measurement of lean body mass based on creatinine excretion (LBMCr) were carried out at baseline, and at 3- month interval thereafter. Responders was defined as those patients who had an increment of mean LBMCr more than 2.0 kg and/or an increase in mean %LBMCr (LBMCr/Body weight) more than 5% during IPAA treatment.
RESULTS
After administration of IPAA, BUN, Cr, LBMCr, %LBMCr, nPNA, SGA, and exercise capacity increased significantly. But, protein and albumin level showed no significant change. Increment of IGF-1 level was significant. At baseline, responders had a significantly higher hand grip and back lift strength compared to non-responders. IPAA treatment significantly increased in BUN, PNA and nPNA in both groups, but the increment of them was pronounced in responders. IPAA resulted in a significant increase in serum creatinine (10.6+/-2.1 vs. 11.8+/-2.6 mg/dL, p<0.05) and %LBMCr (70.8+/-8.9 vs. 76.4+/-9.2%, p<0.05), hand grip strength (23.2+/-7.3 vs. 24.3+/-7.7 kg, p<0.05) and back lift strength (67.0+/-27.4 vs. 75.3+/-26.6 kg, p<0.05) only in responders. Serum albumin level remained stable after IPAA treatment in responders.
CONCLUSION
IPAA treatment for 12 months provided some nutritional benefits in malnourished CAPD patients. And, our data suggest that response to IPAA is more pronounced in CAPD patients with a better preserved nutritional status, especially in those patients with higher back lift and hand grip strength at baseline.