Does the Amino-acid Based Peritoneal Dialysate (Nutrineal®) Change Homocysteine Metabolism in CAPD Patients?

Background Homocysteine has been recognized as an independent risk factor to atherosclerosis and related cardiovascular diseases. The commercialized amino acids-based peritoneal dialysate - Nutrineal® -contains contains different amounts of non~ and essential amino acids. L-Methionine, 85 mg/dl, is present in Nutrineal® and it may affect homocysteine metabolism after its use for certain periods. Patients and Methods 17 Adults CAPD patients (11M 6F) who have received CAPD for at least 6 months and low serum albumin levels (＜ 3.7 g/dl) were enrolled. Diet was not specifically changed. They all received four-exchange CAPD treatment and Nutrineal® was used as once daily substitute, given at the first or second exchange. Blood samples were collected every two weeks and subjected to homocysteine measurement. Results Almost all patients (except one) who used Nutrineal® 2 weeks later got higher homocysteine level compared with before Nutrineal® used (P=0.0131, One-way ANOVA). But there seemed no further progressive elevation of homocysteine level after persisted used of Nutrineal® 4 weeks later. (compared 2wk with 4wk and later, p=0.8128, One-way ANOVA). Conclusion The use of amino-acid based dialysate resulted in increasing the homocysteine level significantly in CAPD patients. However, the progressive progressive elevation of homocysteine level with time didn’t be observed. After a new threshold level of homocysteine was restored, the L-Methionine in the dialysate can’t further involve the homocysteine level.

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