• S P Davies, D A Reaveley, E A Brown, and W J Kox.
• Department of Medicine, Westminster Medical School, London, UK.
• Crit. Care Med. 1991 Dec 1;19(12):1510-5.

ObjectiveTo determine daily amino acid and total protein losses in patients with acute renal failure receiving total parenteral nutrition (TPN) during treatment by continuous arteriovenous hemofiltration with hemodialysis (CAVHD).DesignProspective, nonrandomized study.SettingPatients in the ICU of a regional nephrology referral center.PatientsEight clearance studies of individual amino acids were performed in six patients with acute renal failure receiving TPN. Daily nitrogen intake was 9 g (one patient), 14 g (two patients), and 18 g (three patients). The clearances of individual amino acids were measured at two dialysis flow rates to calculate daily amino acid and total proten losses.ResultsAmino acid clearance rates ranged from 7.8 +/- 2.2 (glutamic acid) to 25.2 +/- 4.8 mL/min (3-methylhistidine) at a dialysate flow rate of 1 L/hr and from 13.6 +/- 1.7 (tryptophan) to 33.7 +/- 4.3 mL/min (3-methylhistidine) at a dialysate flow rate of 2 L/hr. These results represent daily amino acid losses of 1.5 +/- 0.4% (glutamic acid) to 111.6 +/- 16.6% (tyrosine) of the nutritional input at a dialysate flow rate of 1 L/hr and 2.1 +/- 0.6% (glutamic acid) to 145.8 +/- 17.8% (tyrosine) at a dialysate flow rate of 2 L/hr. Total losses would represent 8.9 +/- 1.2% and 12.1 +/- 2.2%, respectively, of the daily protein input.ConclusionsThese studies confirm that amino acid clearances are relatively high during CAVHD and daily losses should therefore be considered.

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