alanine + arginine + calcium chloride dihydrate + 16 other active ingredients: clinical use

Prescribing considerations

• Use as one component of a physician-supervised peritoneal dialysis regimen, particularly where malnutrition is present.
• Correct metabolic acidosis and assess dialysis adequacy before and during treatment.
• Monitor dietary protein intake, nutritional response, fluid balance and body weight.
• Use caution with abdominal-wall or intra-abdominal disease, recent disruption of the peritoneum, aortic grafts or severe pulmonary disease.
• Safety and effectiveness in children have not been established.
• Consider the risk of additional nitrogenous waste and uraemic symptoms if dialysis is inadequate.
• Consider whether low calcium content could worsen secondary hyperparathyroidism.

Contraindications and cautions

• Hypersensitivity to an amino acid or excipient
• Raised serum urea above the product-specified threshold or existing uraemic symptoms
• Metabolic acidosis
• Inborn errors of amino acid metabolism
• Liver insufficiency
• Severe hypokalaemia
• Uncorrectable mechanical defects preventing effective dialysis or increasing infection risk
• Documented loss of peritoneal function or extensive adhesions compromising it

Monitoring

• Fluid balance, body weight and signs of over- or underhydration
• Bicarbonate, potassium, magnesium, calcium and phosphate
• Blood chemistry, including urea and parathyroid hormone
• Haematological parameters
• Blood glucose in diabetes
• Dietary protein intake and nutritional response
• Drained fluid appearance and symptoms of peritonitis
• Uraemic symptoms such as anorexia, nausea or vomiting

Clinical pharmacology

A sterile, non-pyrogenic, glucose-free dialysate. Solute and water exchange occurs by diffusion and osmosis across the peritoneal membrane. Electrolytes undergo normal handling, lactate is a bicarbonate precursor and a substantial proportion of the amino acids is absorbed during the dwell.

Formulation and product differences

• Contains amino acids as the osmotic and nutritional substrate rather than glucose.
• Contains sodium, chloride, lactate, calcium and magnesium but no potassium.
• Available in single-bag and twin-bag systems with an injection port; not all configurations may be marketed.
• For intraperitoneal use only and supplied as a single-use solution in an overwrapped bag.