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  • Title: Whole-body protein turnover in peritoneal dialysis patients: a comparison of the [15N]glycine end product and the [13C]leucine precursor methods.
    Author: Tjiong HL, Swart R, Rietveld T, Wattimena JL, Hop WC, Fieren MW, van den Berg JW.
    Journal: Nephrol Dial Transplant; 2008 Aug; 23(8):2660-5. PubMed ID: 18308773.
    Abstract:
    BACKGROUND: Two well-described methods for measuring whole-body protein turnover (WBPT) are the precursor method using a primed continuous infusion of [1-(13)C]leucine and the end-product method with a single oral dose of [(15)N]glycine. We previously measured the effects of amino acid (AA)-containing dialysate on protein anabolism in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using the [1-(13)C]leucine technique. Here, we examine whether the less invasive [(15)N]glycine method could also be appropriate for studying nutritional interventions. METHODS: We compared the results of WBPT measurements using a single oral dose of [(15)N]glycine with those obtained with the primed continuous infusion of [1-(13)C]leucine during AA and glucose (G) dialysis and G-only dialysis in 12 CAPD patients in the fed state. RESULTS: The end-product method showed a wide variation for protein synthesis and breakdown measurements. It did not detect a small but significant increase in protein synthesis with AA-containing dialysate as shown by the precursor method. However, a significant relation was found between both methods for net protein synthesis (i.e. protein synthesis minus breakdown) during AA and G (r = 0.75, P = 0.005) or during G-only dialysis (r = 0.86, P < 0.001). The agreement between the two methods for the net protein balance was good [intra-class correlation coefficient (ICC) = 0.88] with G-only dialysate and moderate (ICC = 0.70) with AA and G dialysate. CONCLUSION: While the precursor method shows less variation, the more convenient end-product method may be useful in larger groups of selected patients including those on PD.
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