The annual mortality rate of the dialysis patients is more than 20% a year. Increasing number of studies link this increased mortality to poor nutritional status. Several factors related to the uremic state may contribute to the prevalence of protein-energy malnutrition in this patient population. These include anorexia, metabolic or hormonal factors that promote net degradation of protein, decreased biological activity of anabolic hormones such as insulin-like-growth factors as well as abnormalities in the metabolism of individual amino acids and finally, losses of amino acids during dialysis. However there is increasing evidence that the dose of dialysis and the type of dialysis membrane also play an important role in the pathogenesis of this malnutrition. We propose to study the effects of different doses of dialysis and different types of dialysis membranes on the nutritional parameters of patients in a prospective, randomized, cross-over study of sixty hemodialysis dependent patients. Further, we propose to study the effects of a new anabolic hormone, recombinant human growth hormone (rhGH) with and without supplemental intradialytic hyperalimentation on the nutritional parameters of chronic hemodialysis patients. Finally, we propose to explore the effects of rhGH on the nutritional parameters of peritoneal dialysis patients. This study has the potential of defining specific interventions that may improve the nutritional parameters of dialysis patients and may, in the long run, improve on the high mortality rates currently observed in this population.
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