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Hemodial Int. 2016 Oct;20(4):510-521. doi: 10.1111/hdi.12435. Epub 2016 Jun 21.

Reduction of carbamylated albumin by extended hemodialysis.

Author information

1
Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Jeff.perl@utoronto.ca.
2
Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.
3
Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
4
Division of Cardiology, Department of Medicine, Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada.
5
Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
6
Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
7
Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
8
Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School. ahberg@bidmc.harvard.edu.

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.

KEYWORDS:

Carbamylated albumin; carbamylation; cardiac hypertrophy; extended duration hemodialysis; nocturnal hemodialysis; uremia

PMID:
27329430
PMCID:
PMC5380223
DOI:
10.1111/hdi.12435
[Indexed for MEDLINE]
Free PMC Article

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