Increased albumin and fibrinogen synthesis in hemodialysis patients with normal nutritional status.
This study compared the rates of whole-body proteolysis and of albumin and fibrinogen synthesis of seven hemodialysis patients (HD) with those of seven normal matched control subjects (C). HD patients had a normal nutritional and inflammatory status and serum albumin levels >3.5 g/dl. Endogenous leucine flux, albumin and fibrinogen fractional synthesis rate (FSR), and absolute intravascular synthesis rate (ASR) of albumin and fibrinogen all were evaluated by a primed/continuous infusion of 5,5,5-D3-L-leucine. Plasma volume was determined by the Evans blue dye dilution method. Endogenous leucine flux was significantly increased in HD (2.64 +/- 0.08 micromol/kg per min) compared with C (2.17 +/- 0.07 micromol/kg per min, P: < 0.05). Serum albumin concentrations were similar in HD and C. Plasma fibrinogen levels were significantly increased in HD compared with C (P: < 0.05). Plasma volume was greater in HD than in C (P: < 0.05). As a result, total intravascular pool of both albumin (141 +/- 7 versus 114 +/- 3 g/1.73 m(2), P: < 0.05) and fibrinogen (11.7 +/- 1 versus 6.7 +/- 0.5 g/1.73 m(2), P: < 0.05) were greater in HD than in C. Albumin FSR was not statistically different in HD and C. However, albumin ASR was significantly increased in HD than in C (13.7 +/- 2 versus 10.3 +/- 1 g/1.73 m(2) per d, P: < 0.05). Similarly, FSR of fibrinogen did not differ in HD and C groups, whereas ASR of fibrinogen was significantly higher in HD than in C (3.31 +/- 0.6 versus 1.94 +/- 0.3 g/1.73 m(2) per d, P: < 0.05). In summary, normoalbuminemic HD patients have an increased intravascular pool with a greater absolute synthesis rate of both albumin and fibrinogen and an increased rate of whole-body leucine flux.
Giordano
Mauro
M
Istituto di Clinica Medica L. Condorelli, University of Catania, Catania, Italy.
Feo
Pierpaolo DE
P
Dipartimento di Medicina Interna, Scienze Endocrine e Metaboliche, University of Perugia, Perugia Italy.
Lucidi
Paola
P
Dipartimento di Medicina Interna, Scienze Endocrine e Metaboliche, University of Perugia, Perugia Italy.
dePASCALE
Emanuela
E
Istituto di Clinica Medica L. Condorelli, University of Catania, Catania, Italy.
Giordano
Gelsomina
G
Istituto di Medicina Interna e Nefrologia, Second University of Naples, Naples, Italy.
Infantone
Lorena
L
Istituto di Clinica Medica L. Condorelli, University of Catania, Catania, Italy.
Zoccolo
Anna Maria
AM
Istituto di Clinica Medica L. Condorelli, University of Catania, Catania, Italy.
Castellino
Pietro
P
Istituto di Clinica Medica L. Condorelli, University of Catania, Catania, Italy.
D000328:Adult; D005260:Female; D005340:Fibrinogen / Q000096:biosynthesis*; D006461:Hemolysis; D006801:Humans; D007930:Leucine / Q000378:metabolism; D008297:Male; D009752:Nutritional Status; D010953:Plasma Volume; D012709:Serum Albumin / Q000096:biosynthesis*
D012709:Serum Albumin; D005340:Fibrinogen; D007930:Leucine