The studie of Adrian Post focused on hemodialysis patients and kidney transplant recipients.
In hemodialysis patients, using a combined collection of urine and dialysate, we provided an unbiased assessment of their intake of protein, sodium, potassium, and phosphate. This method also revealed that HD patients lose significant amounts of amino acids, guanidinoacetate, and creatine via the dialysate, raising their risk of deficiencies. For instance, low concentrations of creatine were associated with characteristics of protein energy wasting (a state of decreased body protein and energy stores), and lower total creatine pools were associated with a higher risk of premature mortality. Elevated circulating FGF21 was also identified as a potential biomarker for protein-energy wasting. Additionally, higher protein and taurine intake were associated with a reduced risk of severe fatigue.
In kidney transplant recipients, a higher intake of protein and specific amino acids, leucine and taurine, was associated with a reduced risk of adverse outcomes including graft failure and mortality. Furthermore, we demonstrated that KTR, similar to hemodialysis patients, have impaired creatine homeostasis with lower endogenous creatine synthesis rates and total creatine pools compared to controls. Lower kidney function was associated with reduced endogenous creatine synthesis. Lower circulating creatine concentrations and lower total creatine pools were in term associated with increased risk of fatigue, reduced quality of life, and premature mortality.
The cumulative findings emphasize the importance of adopting a comprehensive approach to the management of hemodialysis patients and kidney transplant recipients, taking into account dietary intakes, muscle status and creatine homeostasis.
