Amino Acid and Protein Losses in Adult Patients Receiving Maintenance Dialysis: A Literature Review.

BACKGROUND

A comprehensive, scoping review was initiated with the aim of providing an update regarding amino acid/protein losses in maintenance hemodialysis/hemodiafiltration (HD/HDF), peritoneal dialysis (PD), home HD (HHD), and nocturnal HD (NHD).

METHODS

From 2000 to 2024, all records that measured amino acid and peptide/protein losses in the dialysate effluent were included.

RESULTS

Twenty-nine eligible records were identified (14 HD/15 PD). Amino acid losses ranged from 9.3 ± 2.9 g to 12.0 ± 2.0 g per 4-hour HD session and 0.314 g to 0.522 g/day in PD. Albumin losses ranged from 0.448 g to 3.99 g per HD/HDF session and 4.23 g to 6.12 g/day in PD. Albumin losses were higher with postdilution HDF compared to HD. Total protein losses were not reported in HD studies. Daily protein losses in PD ranged from 4.37 ± 1.71 g to 10.0 ± 0.6 g. No studies in home HD or nocturnal HD populations were identified.

CONCLUSION

Amino acid/protein losses differ between HD/HDF and PD. Since PD occurs daily, patients receiving PD have greater weekly amino acid/protein losses than HD. Whether individualized replacement of these losses is linked to better clinical outcomes needs to be further explored.