A Comparison of Essential and General Amino Acid Infusions in the Nutritional Support of Patients with Compromised Renal Function

A comparative study of an essential amino acid (EAA) solution versus a general amino acid (GAA) solution in combination with a high density caloric solution (350 gram dextrose per 750 milliliter total volume) in patients with impaired renal function and receiving total parenteral nutrition was conducted. Forty-five patients were randomly assigned to receive either EAA [17 grams per liter (24)] or GAA [20 grams per liter (21)]. BUN values for days 1 to 10 of the study for each group declined at the same rate, 3.7 milligrams per deciliter per day for the GAA group and 2.8 milligrams per deciliter per day for the EAA group (p > 0.05, analysis of variance). BUN values at the start of the study were 78 ± 6.5, mean ± standard error of mean milligram per deciliter for the GAA group and 75 ± 7.5, mean ± standard error of mean, mg/dl for the EAA` group which were not different (p > 0.05, analysis of variance). Serum creatinine values of 5.9 ± 0.9, mean ± standard error of mean, milligram per deciliter for the GAA group and 5.0 ± 0.6, mean ± standard error of mean, milligram per deciliter for the EAA group remained the same and there was no significant difference between groups over days 1 to 10 of the study (p > 0.05, analysis of variance). Urine urea nitrogen was determined twice weekly and estimated nitrogen balance, urea appearance rate, and net protein utilization were calculated. There were no significant differences found in any of these parameters between groups (p > 0.05, Student unpaired t-test). Serum potassium, magnesium, and phosphate were the same between groups over the study period (p > 0.05, Student unpaired t-test). The mortality rate of 38 and 25% in the GAA and EAA groups, respectively, was not significantly different (p = 0.32, Fisher's exact probability test). In this study, there was no demonstrable advantage to the use of the essential amino acid solution when compared with a reduced concentration general amino acid solution for parenteral nutrition in renal failure patients.