title: Middle molecule clearance does not influence protein intake in hemodialysis patients.
abstract: Nutritional status in hemodialysis patients is a strong predictor of morbidity and mortality. To isolate the impact of dialyzer flux on nutrition in hemodialysis patients, we compared the nutritional effect of high-flux dialysis with that low-flux dialysis, using a biocompatible membrane for both. Sixty-five patients were monitored for 8 months after changing to high-flux dialysis with a F80 polysulfone dialyzer following a 6-month baseline period of low-flux dialysis with a F8 polysulfone dialyzer. The Kt/V and normalized protein catabolic rate (nPCR) were the same on both the F8 and F80 dialyzers. The regression of nPCR versus Kt/V was also nearly identical. Despite the unchanged protein intake, the serum albumin (3.86 to 4.04 g/dL; P < 0.01) and serum creatinine (10.3+/-0.2 mg/dL to 11.2+/-0.3 mg/dL; P < 0.05) significantly increased during 8 months of high-flux dialysis. Therefore, we conclude that the increased removal of middle molecules by high-flux dialysis has no apparent effect on appetite as measured by nPCR, but it has a beneficial effect on serum albumin and serum creatinine, suggesting a role for middle molecules in the control of albumin and protein synthesis in the body.
authors.affiliation: Department of Medicine, Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Marcus
authors.forename: E
authors.initials: E
authors.lastname: Cohl
authors.forename: J
authors.initials: J
authors.lastname: Uribarri
mesh_terms: D001066:Appetite; D001672:Biocompatible Materials; D003404:Creatinine / Q000097:blood; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D008970:Molecular Weight; D009752:Nutritional Status; D011108:Polymers; D011506:Proteins / Q000378:metabolism*; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods; D012709:Serum Albumin / Q000032:analysis; D013450:Sulfones; D014508:Urea / Q000378:metabolism
chemical_list: D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011108:Polymers; D011506:Proteins; D012709:Serum Albumin; D013450:Sulfones; C017662:polysulfone P 1700; D014508:Urea; D003404:Creatinine