Amino Acid Supplementation in Dialysis Patients

Protein and Amino Acid Requirements

The American Journal of Kidney Diseases recommends aiming for a total protein intake of 1.2 g/kg/day for stable maintenance hemodialysis patients, with at least 50% from high biological value sources 1, 2
For peritoneal dialysis patients, the recommended protein intake is 1.2-1.3 g/kg/day, with at least 50% from high biological value sources 2, 6
Each hemodialysis session removes approximately 10-12 g of amino acids, creating substantial ongoing losses that must be replaced 1, 4
More intensive dialysis schedules may require protein intakes exceeding 1.2-1.3 g/kg/day due to increased amino acid removal 1, 5

The American Journal of Kidney Diseases recommends a target energy intake of 35 kcal/kg/day for patients <60 years, and 30-35 kcal/kg/day for patients ≥60 years 2, 6
Energy expenditure in dialysis patients is similar to healthy individuals, supporting these recommendations 2, 6
Adequate energy intake is essential to maintain neutral nitrogen balance and prevent protein from being catabolized for energy 2, 6

The American Journal of Kidney Diseases recommends supplementation of water-soluble B vitamins due to dialytic losses 7
Folic acid supplementation is recommended at 1 mg/day 3
Pyridoxine (B6) supplementation is recommended at 10-20 mg/day 3, 7

Routine L-carnitine supplementation is not recommended for all maintenance dialysis patients 1, 4
L-carnitine may improve subjective symptoms in selected patients, but evidence is insufficient for routine use 1, 4

Monitor serum albumin every 1-4 months, with a target of maintaining in the normal range 8
Calculate normalized protein nitrogen appearance (nPNA), with a target of ≥0.9 g/kg/day 8
Evaluate body mass index (BMI), with concern if <20 kg/m² 3
Assess for >10% body weight loss over 6 months 3