Reduction of carbamylated albumin by extended hemodialysis |
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Authors: | Jeffrey Perl Sahir Kalim Ron Wald Marc B Goldstein Andrew T Yan Nazanin Noori Mercedeh Kiaii Julia Wenger Christopher Chan Ravi I Thadhani S Ananth Karumanchi Anders H Berg |
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Affiliation: | 1. Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada;2. Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA;3. Division of Cardiology, Department of Medicine, Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada;4. Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;5. Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada;6. Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;7. Department of PathologyBeth Israel Deaconess Medical Center and Harvard Medical School |
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Abstract: | Introduction Among conventional hemodialysis (CHD) patients, carbamylated serum albumin (C‐Alb) correlates with urea and amino acid deficiencies and is associated with mortality. We postulated that reduction of C‐Alb by intensive HD may correlate with improvements in protein metabolism and cardiac function. Methods One‐year observational study of in‐center nocturnal extended hemodialysis (EHD) patients and CHD control subjects. Thirty‐three patients receiving 4‐hour CHD who converted to 8‐hour EHD were enrolled, along with 20 controls on CHD. Serum C‐Alb, biochemistries, and cardiac MRI parameters were measured before and after 12 months of EHD. Findings EHD was associated with reduction of C‐Alb (average EHD change ?3.20 mmol/mol 95% CI ?4.23, ?2.17] compared to +0.21 95% CI ?1.11, 1.54] change in CHD controls, P < 0.001). EHD was also associated with increases in average essential amino acids (in standardized units) compared to CHD (+0.38 0.08, 0.68 95%CI]) vs. ?0.12 ?0.50, 0.27, 95% CI], P = 0.047). Subjects who reduced C‐Alb more than 25% were found to have reduced left ventricular mass, increased urea reduction ratio, and increased serum albumin compared to nonresponders, and % change in C‐Alb significantly correlated with % change in left ventricular mass. Discussion EHD was associated with reduction of C‐Alb as compared to CHD, and reduction of C‐Alb by EHD correlates with reduction of urea. Additional studies are needed to test whether reduction of C‐Alb by EHD also correlates with improved clinical outcomes. |
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Keywords: | Carbamylated albumin carbamylation cardiac hypertrophy extended duration hemodialysis nocturnal hemodialysis uremia |
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