Serum Guanidino Compound Levels and the Influence of a Single Hemodialysis in Uremic Patients Undergoing Maintenance Hemodialysis

Abstract

Guanidino compounds are increased in uremia and are highly suspected to be uremic toxins. The serum levels of 11 guanidino compounds and the influence of a single hemodialysis were evaluated in 30 steady-state uremic patients undergoing maintenance hemodialysis. Guanidino compound levels were detected using liquid cation exchange chromatography with a highly sensitive fluorescence detection method. Highly standardized dialysis procedures were performed. Before hemodialysis, high levels were found for guanidinosuccinic acid, N-α-acetylarginine, argininic acid, creatinine, γ-guanidinobutyric acid, guanidine and methylguanidine. Guanidinosuccinic acid reached levels associated with toxic effects in vitro. After hemodialysis, although lowered, guanidinosuccinic acid, creatinine, guanidine and methylguanidine were still markedly increased. No differences in the percent decrease, during a single hemodialysis, of the studied compounds were found using different membranes such as cellulose acetate, cuprophane and polyacrylonitrile membranes. Substantial differences, however, in the percent decrease of the different guanidino compounds were found, ranging from 25 ± 13% for arginine to 74 ± 7.5% for guanidinosuccinic acid. Data reported here show that guanidino compounds are raised in serum of uremic patients undergoing maintenance hemodialysis, before as well as after a single hemodialysis, while substantial differences in the percent decrease of the different guanidino compounds are found.

Depressed Natural Killer Cell Activity in Uremia

“…This result indicates the possibility that the nondialyzable factor is not involved in the defective NK cell activity in uremia. Guanidino compounds, highly suspected to be uremic toxin, are dialyzable and the percent decrease of them during a single HD has been reported not to be different between cuprophane, cellu lose acetate and polyacrylonitrile subgroups [27]. No differences in defective NK cell activity were found be tween patients treated with cuprophane, ethylene vinylalcohol copolymer and polyacrylonitrile membranes in our study.…”

Reduced production of nitric oxide during haemodialysis

“…Renal failure is often accompanied by hypertension, and interestingly, patients with renal failure have been shown to possess high levels of guanidinosubstituted analogues of l-arginine compounds that inhibit NO synthesis. [5][6][7] Since guanidino compounds can be removed by dialysis, 8 their serum levels should decrease after haemodialysis in uraemic patients. In contrast to the hypertensionrelated effects of NO, overproduction of NO due to cantly by the end of haemodialysis (42 ؎ 26 M).…”

Serum Guanidino Compound Levels and Clearances in Uremic Patients Treated with Continuous Ambulatory Peritoneal Dialysis

“…Although several reports demonstrated a variety of GCs to be increased in blood, urine and cerebrospinal fluid of nondialyzed [1][2][3][4][5][6][7]10] as well as hemodialyzed uremic patients [1,[7][8][9], only few data on GC levels in biological fluids of CAPD-treated uremic patients are available. Previous reports studying the levels and clear ances of GCs dealt only with CTN [34][35][36][37][38][39][40][41] and one report considered GSA [11].…”