The nutritional status of patients on chronic maintenance hemodialysis has now been shown in multiple studies to be one of the major factors predictive of subsequent morbidity and mortality. Patients with poor nutrition intake on dialysis have a negative nitrogen balance and have been shown to be at high risk for cardiovascular events and for serious infectious complications. A large population of these high risk patients are readily identifiable in any chronic dialysis population. In this study, we propose to investigate two approaches to nutritional supplementation in this patient population. One is to use parenteral amino acids and glucose infusions alone during dialysis and the other is to supplement this with exogenous growth hormone. The completion of both arms of this study will potentially yield new information about the ability of dialysis patients to reverse a catabolic process. The development of an effective treatment modality that results in positive nitrogen balance can have a major impact on patient morbidity and mortality. Animal studies suggest that this is a potential form of therapy. The demonstration of increased anabolic (or even decreased catabolic) effects of growth hormone in the dialysis patient population could have enormous impact on dialysis patient morbidity and survival, particularly for those all to common patients with poor nutritional intake.
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