FIGURE 2.

Effect of (a) no protein ingestion and (b) protein ingestion during hemodialysis on muscle protein synthesis and breakdown rates throughout the day. Because of amino acid removal during hemodialysis, muscle protein breakdown rates increase and exceed synthesis rates. In fasted patients, this catabolic period continues even after the end of the hemodialysis session. Ingestion of ample protein during hemodialysis stimulates muscle protein synthesis rates and inhibits breakdown rates, allowing net muscle accretion. MPB, muscle protein breakdown; MPS, muscle protein synthesis.