Amino acid profile in patients of chronic kidney disease on hemodialysis in Indonesia

Protein energy wasting (PEW) is a nutritional disorder syndrome that occurs 28 - 80% in chronic kidney disease (CKD) patients on hemodialysis. Hemodialysis cause the nutrients loss including amino acids, increase protein catabolism induced by inflammation, and inhibit protein synthesis. The objective of this study was to acquire the amino acid profile in CKD patients on hemodialysis. This study used cross sectional design and involving 60 subjects of CKD patients aged >18 years on routine hemodialysis at Dr. Cipto Mangunkusumo National Referral Hospital. Amino acids examination was using dried blood spots (DBSs) sample and Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) method. We examined 10 non-essential (alanine, arginine, aspartic acid, glutamic acid, asparagine, glycine, glutamine, proline, serine, tyrosine), 9 essentials (histidine, phenylalanine, isoleucine, leucine, lysine, methionine, threonine, tryptophan, valine), and 2 special (ornithine, citrulline) amino acids. The results showed that almost all amino acids were lower (6 non-essential, 8 essentials, and citrulline), whereas others were higher (aspartate acid, serine) or normal (glutamic acid, glycine, methionine, and ornithine) than normal reference value from Mayo. CKD patients on hemodialysis have decreased amino acid especially essential amino acids. These results can be used in modification of amino acid supplementation CKD patient on hemodialysis in Indonesia.