A randomized controlled trial of alanyl-glutamine supplementation in peritoneal dialysis fluid to assess impact on biomarkers of peritoneal health | Zendy

Andreas Vychytil | Zendy; Rebecca Herzog | Zendy; Paul Probst | Zendy; Werner Ribitsch | Zendy; Karl Lhotta | Zendy; Veronika Machold-Fabrizii | Zendy; Martin Wiesholzer | Zendy; Michaela Kaufmann | Zendy; H. Peter Soyer | Zendy; Martin Windpessl | Zendy; Alexander R. Rosenkranz | Zendy; Rainer Oberbauer | Zendy; Franz König | Zendy; Klaus Kratochwill | Zendy; Christoph Aufricht | Zendy

Open Access

A randomized controlled trial of alanyl-glutamine supplementation in peritoneal dialysis fluid to assess impact on biomarkers of peritoneal health

Author(s) -

Andreas Vychytil,

Rebecca Herzog,

Paul Probst,

Werner Ribitsch,

Karl Lhotta,

Veronika Machold-Fabrizii,

Martin Wiesholzer,

Michaela Kaufmann,

H. Peter Soyer,

Martin Windpessl,

Alexander R. Rosenkranz,

Rainer Oberbauer,

Franz König,

Klaus Kratochwill,

Christoph Aufricht

Publication year - 2018

Publication title -

kidney international

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 3.499

H-Index - 276

eISSN - 1523-1755

pISSN - 0085-2538

DOI - 10.1016/j.kint.2018.08.031

Subject(s) - medicine , peritoneal dialysis , peritoneal fluid , ex vivo , crossover study , peritoneal equilibration test , peritonitis , gastroenterology , randomized controlled trial , ascites , placebo , glutamine , in vivo , pathology , continuous ambulatory peritoneal dialysis , biochemistry , chemistry , alternative medicine , microbiology and biotechnology , amino acid , biology

In early clinical testing, acute addition of alanyl-glutamine (AlaGln) to glucose-based peritoneal dialysis (PD) fluids restored peritoneal cellular stress responses and leukocyte function. This study was designed to test the effect of extended treatment with AlaGln-supplemented PD fluid on biomarkers of peritoneal health. In a double-blinded, randomized crossover design, stable PD patients were treated with AlaGln (8 mM) or placebo added to PD fluid for eight weeks. As primary outcome measures, dialysate cancer-antigen 125 (CA-125) appearance rate and ex vivo stimulated interleukin-6 (IL-6) release were assessed in peritoneal equilibration tests. In 8 Austrian centers, 54 patients were screened, 50 randomized, and 41 included in the full analysis set. AlaGln supplementation significantly increased CA-125 appearance rate and ex vivo stimulated IL-6 release. AlaGln supplementation also reduced peritoneal protein loss, increased ex vivo stimulated tumor necrosis factor (TNF)-α release, and reduced systemic IL-8 levels. No adverse safety signals were observed. All 4 peritonitis episodes occurred during standard PD fluid treatment. A novel AlaGln-supplemented PD fluid improves biomarkers of peritoneal membrane integrity, immune competence, and systemic inflammation compared to unsupplemented PD fluid with neutral pH and low-glucose degradation. A phase 3 trial is needed to determine the impact of AlaGln supplementation on hard clinical outcomes.

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