Dialysis Procedures Alter Metabolic Conditions

Abstract

A progressive chronic kidney disease results in retention of various substances that more or less contribute to dysfunction of various metabolic systems. The accumulated substances are denominated uremic toxins. Although many toxins remain undetected, numerous newly defined toxins participate in the disturbance of food breakdown. In addition, toxic effects may downregulate other pathways, resulting in a reduced ability of free fatty acid breakdown by lipoprotein lipase (LPL) and hepatic lipase (HL). Dialysis may even worsen metabolic functions. For LPL and HL, the use of heparin and low molecular weight heparin as anticoagulation during hemodialysis (HD) initiate a loss of these enzymes from their binding sites and degradation, causing a temporary dysregulation in triglyceride breakdown. This lack of function will cause retention of the triglyceride containing lipids for at least 8 h. In parallel, the breakdown into free fatty acids is limited, as is the energy supply by them. This is repeated thrice a week for a normal HD patient. In addition, dialysis will cause a loss of amino acids and disturb glucose metabolism depending on the dialysates used. The addition of glucose in the dialysate may support oxidation of carbohydrate and the retention of Amadori products and subsequent tissue alterations. To avoid these effects, it seems necessary to further study the effects of anticoagulation in HD, the extent of use of glucose in the dialysate, and the supplementation of amino acids.

The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD

“…54 However, acute changes in plasma and tissue concentration in dialyzable substances, including electrolytes, major "uremic" metabolic products, and other, known or unknown, molecules may activate additional mechanisms that can compromise myocardial function, such as high-energy phosphate depletion, micro-vascular hypoperfusion, impaired sympathetic response, and reactive oxygen species generation. 55,56 Such mechanisms induce calcium-dependent protease activity and result in troponin I proteolysis and intracellular calcium depletion. 57,58 Consequently, a hemodialysis-induced relative "ischemia" occurs during sessions followed by delayed recovery of regional myocardial contractile function, a phenomenon known as "myocardial stunning," exemplified with elegant studies with H 2 15 O PET scanning, as discussed above.…”

Long‐Term Survival for Hemodialysis Patients Differ in Japan Versus Europe and the USA. What Might the Reasons Be?

“…Triglyceride levels are modified by what the patient eats directly before and during dialysis treatments. Triglyceride levels are also increased by heparin, which limits triglyceride breakdown for several hours after the start of dialysis . Japanese patients rarely eat during dialysis treatments.…”

Blood Fatty Acid Status and Clinical Outcomes in Dialysis Patients: A Systematic Review

“…However, blood FA profiles are altered in the presence of chronic diseases, such as chronic respiratory diseases [ 12 ], systemic lupus erythematosus [ 13 ], cancer [ 14 ], chronic gastrointestinal disorders [ 15 ], and chronic kidney disease (CKD) [ 16 ]. Of note, related to the topic of the present review, the dialysis procedure itself affects FA metabolism [ 17 ] and alters the blood FA composition [ 18 ]. In context, the impact of dialysis on blood FA profiles and its potential implications needs to be better understood.…”