Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients.
Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients.
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透析中肠外营养可改善慢性血液透析患者的蛋白质和能量稳态。
DOI：
10.1172/jci15449
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
Ikizler,TAlp
中科院分区：
文献类型：
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作者：
Pupim,LaraB;Flakoll,PaulJ;Brouillette,JohnR;Levenhagen,DeannaK;Hakim,RaymondM;Ikizler,TAlp
膳食蛋白质摄入量减少和血液透析相关蛋白质代谢紊乱是导致慢性血液透析（CHD）患者蛋白质热量营养不良的几个因素。由于试图通过饮食咨询增加蛋白质摄入通常是无效的，透析中肠外营养（IDPN）已被提议作为营养不良CHD患者的潜在治疗方法。在这项研究中，我们研究了蛋白质和能量稳态血液透析中的7例冠心病患者在两个单独的血液透析会议，与IDPN管理。患者在血液透析前2小时、透析中和透析后2小时进行研究，使用预充的L-（1- 13 C）亮氨酸和L-（环-2H5）苯丙氨酸持续输注。我们的研究结果表明，IPDN促进了全身蛋白质合成的大幅增加和全身蛋白质水解的显着减少，沿着前臂肌肉蛋白质合成的显着增加。最终的结果是从基本上分解代谢的状态转变为高度正的蛋白质平衡，无论是在全身还是前臂肌肉区室。我们的结论是，提供的热量和氨基酸在血液透析与IDPN急性逆转净负全身和前臂肌肉蛋白质平衡，表明需要长期的临床试验评估IDPN营养不良的CHD患者。
Decreased dietary protein intake and hemodialysis-associated protein catabolism are among several factors that predispose chronic hemodialysis (CHD) patients to protein calorie malnutrition. Since attempts to increase protein intake by dietary counseling are usually ineffective, intradialytic parenteral nutrition (IDPN) has been proposed as a potential therapeutic approach in malnourished CHD patients. In this study, we examined protein and energy homeostasis during hemodialysis in seven CHD patients at two separate hemodialysis sessions, with and without IDPN administration. Patients were studied 2 hours before, during, and 2 hours following a hemodialysis session, using a primed constant infusion ofL-(1-13C) leucine andL-(ring-2H5) phenylalanine. Our results showed that IPDN promoted a large increase in whole-body protein synthesis and a significant decrease in whole-body proteolysis, along with a significant increase in forearm muscle protein synthesis. The net result was a change from an essentially catabolic state to a highly positive protein balance, both in whole-body and forearm muscle compartments. We conclude that the provision of calories and amino acids during hemodialysis with IDPN acutely reverses the net negative whole-body and forearm muscle protein balances, demonstrating a need for long-term clinical trials evaluating IDPN in malnourished CHD patients.