title: Reduction of carbamylated albumin by extended hemodialysis.
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.
authors.affiliation: Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Jeff.perl@utoronto.ca.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perl
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Sahir
authors.initials: S
authors.lastname: Kalim
authors.affiliation: Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.affiliation: Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Goldstein
authors.affiliation: Division of Cardiology, Department of Medicine, Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.affiliation: Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Noori
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mercedeh
authors.initials: M
authors.lastname: Kiaii
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Wenger
authors.affiliation: Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chan
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Ravi I
authors.initials: RI
authors.lastname: Thadhani
authors.affiliation: Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School. ahberg@bidmc.harvard.edu.
authors.forename: Anders H
authors.initials: AH
authors.lastname: Berg
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012709:Serum Albumin / Q000378:metabolism*; D014508:Urea / Q000378:metabolism
chemical_list: D012709:Serum Albumin; D014508:Urea
keywords: Carbamylated albumin; carbamylation; cardiac hypertrophy; extended duration hemodialysis; nocturnal hemodialysis; uremia