p.85 PERDIALYTIC PARENTERAL NUTRITION (PDPNJ WITH LIPIDS AND AMINO A~ll~b (AA) IN MALNOURISHED HEMoDIALYSED (HD) PATIENTS. N Can0 _I_____, J. Labastie- Coeyrehourcq, P. Lacombe, J. di Costanzo-Dufetel, J.P. Durbec, C. Coudray-

Lucas, O.G. Ekindjian. Clinique Residence du Part, Hdpital de la Timone, INSERM U31, Marseilles, CNRS UA 622, Chatenay, France.

In HD adults free of liver and infLammatory disease, serum TBPA<300 mg/l indicates poor nutritional status and outcome (1). In 26 of such patients. aged 20 to 70, we studied the nutritional effects of a 3-month PDPN.

Twelve of these patients were randomly assigned to receive PDPN and 14 were consi ered as controls. PDPN was composed of fat (1.6 g/Kg BW, 20 % Intralipid

@& Kabi-Vitrum Lab.) and nitrogen (0.08 g/Kg BW). The AA mixture

(Lexanutril R. Bellon Lab.) comprised non-essential and essential AA including tyrosine. PDPN (16 ml/Kg BW) was intravenously infused 3 times s week during a n-hour HD. The following parameters were monitored during the study : 1/ post-dialysis BW, TSF and AMC, 2/ predialysis serum albumir

TBPA, lymphocyte count and AA, 3/ interdialytic creatinine appearance(CRA; 4/ fasting serum cholesterol (CH), triglycerides (TG), phospholipids (PL), apoprotein (APO) Al and B, 5/ skin test score (STS), 6/ dietary intake(D1)

Control and PDPN patient data were similar before the study. During the study the PDPN group was characterized by : 1) a significant gain in BW

(P < 0.011, AMC (p 4 0.05), TBPA (pdO.O5), Albumin (pLO.O5), CRA(p<O.Ol: :;TS (~(0.05) and total DI (p<O.O5), 2) an increase in serum Apo Al (p( 0.05) without modification of CH, TG, PL and Apo B. PDPN did not modify uremia-related plasma AA disturbances.

Thus lipid and AA PDPN appeared to be nutritionally effective and safe with respect to plasma lipids and dietary intake.

(I) Kidney Int. 1987 : Vol. 32, Suppl. 22, S178 - S180.

p.86 ORNITHINE ALPHA-CETO GLUTARATE (OKG) IN HEMODIALYSED (HD) PATIENTS : META-

BOLISM AND NUTRITIONAL EFFECTS. N Can0 C. _I_---_' Coudray-Lucas, L. Cynober, P.

Lacombe, J. Labastie-Coeyrehourcq, J.P. Durbec, J. di Costanzo-Dufetel,

J.P. Fernandes. Clinique Residence du Part, H6pital de la Timone, INSERM

u31, Marseilles, CNRS UA 622, Chatenay, France.

OKG metabolism and nutritional effects have not yet been investigated in HD patients. We report here : 1) a study of OKG effects on plasma amino acid (AA) kinetics and 2) a controlled trial of OKG in malnourished HD pa-

tients.

1) OKG (10 g) was orally given to 5 fasting HD and 6 control odults.Plnsma samples were obtained before OKG ingestion (t 0) and every 30 mn from 0 to

210 mn (t 30 to t 210) for AA determinations. In controls OKG induced a

rise in ornithine (ORN) with a peak level at t 60 (p c 0.01) and a de- crease after t 120 (p 4 0.05). Arginine (ARG) (p < 0.05) and glutamate

(GLU) (p < 0.1) simultaneously rose. In HD patients ORN reached its peak level at t 90 (p< 0.01) and then stayed at a plateau until t 210. ARG was not modified and GLU decreased at t 150 (p < 0.05).

2) OKG was tested over a 3-month period in 2 groups of malnourished HD edults. Group I (12 patients) received perdialytic parenteral nutrition (PDPN : 16 Kcal, 0.08 g nitrogen/Kg/dialysis) while Group II (14 patients) did not. Six patients in Group I and 7 in Group II received OKG (10 g/day orally). Other patients were given a placebo. Anthropometric data, plasma YaPA, Albumin and AA, interdialytic creatininr appearance and dietary In- take were monitored. OKG failed to improve any of these parameters 1n Grollp I as in Group II.

Plama ORN, ARG and GLU kinetics after OKG ingestion reflects an impairrri utilization of this product in uremia. OKC dysmetabolism in HD patlen!:; co~lld explain its lack of nutritional effeci.

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