One-Percent Amino Acid as a Non-Glucose Containing Peritoneal Dialysis Solution: Effects on Insulin, Respiratory Quotient and Pressor Hormones

R. Krapf*, P. Zabetakis, B. Glace*, N. Stachenfeld*, G. Gleim, M. DeVita, M. Michelis

Nephrology Section and NISMAT, Lenox Hill Hospital, N.Y., N.Y

Plasma renin activity (PRA) and norepinephrine (NE) have been observed to be elevated in patients undergoing CAPD (Clin. Nephrol.28:147,1987). Glucose loading with hyperinsulinemia has been proposed as a mechanism for these findings. The acute effects of a non-glucose containing solution on these pressor hormone levels was evaluated in 5 CAPD patients. Each was studied twice one week apart with an intraperitoneal infusion of either a 1.5% dextrose or a 1% amino acid (AA) solution. The order of the infusions was random. The subjects reported at 0730 hr having drained their abdomen the night before at 2200 hr. Blood samples were obtained at baseline and hourly for 4 hrs after the infusion. Respiratory Quotient (RQ) was measured with a flow-thru ventilation system. The data was analyzed by area under the curve, time vs concentration, utilizing the method of trapezoids.

                           1.5% Dext.          1% AA             p
                         --------------    -------------       -----
    Glucose,mg%*hr       103.0 +/- 13.7    92.0 +/- 11.8       0.02
    Average RQ           0.79  +/- 0.01    0.74 +/- 0.02       0.01
    Insulin,uU/ml*hr     31.0  +/- 14.8    37.0 +/- 17.6       0.15
    PRA,ng/ml            2.98  +/- 0.52    3.53 +/- 1.22       0.72
    NE, pg/ml*hr         2185  +/- 911     3460 +/- 1532       0.36

Infusion of -1.5% Dextrose resulted in higher blood glucose levels and carbohydrate metabolism as denoted by the elevated RQ. Despite the absence of glucose loading during instillation of 1%AA , insulin levels were elevated. PRA, NE, and blood pressure levels were not different. These findings demonstrate that acute hyperinsulinemia and elevated levels of PRA and NE are not avoided by the use of 1 % Amino Acid.