Amino acid and alpha-keto acid metabolism depends on oxygen availability in chronic hemodialysis patients.

Amino acid and alpha-keto acid metabolism depends on oxygen availability in chronic hemodialysis patients. Malnutrition in hemodialysis (HD) patients with renal anemia is reflected in an abnormal plasma amino acid profile. We wished to determine the extent to which malnutrition can be improved by correcting anemia with recombinant human erythropoietin (rhEPO) and supplemental iron. As specific parameters we measured and compared the plasma concentrations of the branched-chain amino acids valine, leucine and isoleucine and their transamination products - major participants in proteolysis and protein biosynthesis - using HPLC with fluorescence detection in 45 severely anemic HD patients (group A: Hb 7.2 +/- 0.8 g/dl), 34 patients with partially corrected anemia (group B: Hb 10.3 +/- 0.6 g/dl) and 35 HD patients with totally corrected anemia (group C: Hb 13.5 +/- 0.7 g/dl). Sixty healthy subjects (group N: Hb 14.2 +/- 1.1 g/dl) served as controls. Correlating with the degree of correction (A/B/C/N), a significant shift to anabolic metabolism was observed in the plasma levels of valine: 130/146/155/205 micromol/l; leucine: 73/71/80/110 micromol/l and alpha-ketoisocaproate (KIC): 11.4/11.8/15.1/ 30.4 micromol/l. It is concluded that energy metabolism becomes increasingly anabolic as hemoglobin levels are normalized.