Journal
HEMODIALYSIS INTERNATIONAL
Volume 20, Issue 4, Pages 510-521Publisher
WILEY-BLACKWELL
DOI: 10.1111/hdi.12435
Keywords
Carbamylated albumin; carbamylation; cardiac hypertrophy; extended duration hemodialysis; nocturnal hemodialysis; uremia
Categories
Funding
- Amgen
- Canada Baxter Healthcare
- Otsuka
- Janssen Ortho Shire
- Takeda
- Baxter Healthcare
- Heart and Stroke Foundation of Ontario
- CIHR [MOP 89982]
- Howard Hughes Medical Institute
- National Institutes of Health [K24 DK094872, R01 DK094486, K08 HL121801]
- American Diabetes Association Innovation award [1-15-IN-02]
- Arbor Research Collaborative for Health
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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 cardiacMRI 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 ventricularmass, 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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