Abstract
Chronic uremia is often associated with impaired utilization of glucose, presumably intracellularly, since it is not dependent on insulin or insulin redeptors. Using the circulating polymophonuclear leukocyte (PMNL) as a cell model, 9 nondialyzed & 26 stable, maintenance hemodialyzed adults with chronic uremia (residual Ccr < 5ml/min) had significantly reduced levels of glycolytic enzyme activities pyruvate kinase (PK) & glucose -6-PO4 dehydrogenese (G6PDH), ATP, & adenylate kinase (AK), protein (3 H Leu) & RNA (3H-URI) synthesis, compared to 32 normal control subjects (blood donors). Following in vitro incubation of isolated PMNL in Krebs-Henseleit medium with 5mM glucose, cell levels of the glycolytic metabolites G6P, F6P, & F-1-6-P were reduced, while DHAP, 3-PGA & PEP were increased, indicating a perturbation in glycolytic flux (GF), although lactate production was not impaired. Hemodialysis improved AK activity & protein synthesis (PS), but G6PDH & ATP decreased. Lactate production by incubated PMNL fell. The postdialysis changes reverted to predialysis values within 1 week. Stable maintenance hemodialysis patients got 500ml amino acid infusions (AAI) (Aminosyn 10%) at the end of each 3×/week dialysis. After 12 infusions (1 month), predialysis ATP levels & PS reached normal levels. GF lactate production was unaffected but triose phosphate levels increased. To the extent that PMNL s reflect cell metabolism, the data is consistent with a cellular defect in glycolysis & protein synthesis in chronic uremics. Dialysis, coupled with AAI, improves cell functions.
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Metcoff, J., Costiloe, P., Pederson, J. et al. 1525 CELL FUNCTIONS IN UREMIA IMPROVED BY DIALYSIS AND AMINO ACID INFUSIONS. Pediatr Res 15 (Suppl 4), 697 (1981). https://doi.org/10.1203/00006450-198104001-01548
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DOI: https://doi.org/10.1203/00006450-198104001-01548