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Nutrients 2017, 9(6), 548; doi:10.3390/nu9060548

Dialysis Procedures Alter Metabolic Conditions

Department of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
Received: 7 March 2017 / Revised: 25 April 2017 / Accepted: 23 May 2017 / Published: 27 May 2017
(This article belongs to the Special Issue Nutrition and Chronic Kidney Disease)
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Abstract

A progressive chronic kidney disease results in retention of various substances that more or less contribute to dysfunction of various metabolic systems. The accumulated substances are denominated uremic toxins. Although many toxins remain undetected, numerous newly defined toxins participate in the disturbance of food breakdown. In addition, toxic effects may downregulate other pathways, resulting in a reduced ability of free fatty acid breakdown by lipoprotein lipase (LPL) and hepatic lipase (HL). Dialysis may even worsen metabolic functions. For LPL and HL, the use of heparin and low molecular weight heparin as anticoagulation during hemodialysis (HD) initiate a loss of these enzymes from their binding sites and degradation, causing a temporary dysregulation in triglyceride breakdown. This lack of function will cause retention of the triglyceride containing lipids for at least 8 h. In parallel, the breakdown into free fatty acids is limited, as is the energy supply by them. This is repeated thrice a week for a normal HD patient. In addition, dialysis will cause a loss of amino acids and disturb glucose metabolism depending on the dialysates used. The addition of glucose in the dialysate may support oxidation of carbohydrate and the retention of Amadori products and subsequent tissue alterations. To avoid these effects, it seems necessary to further study the effects of anticoagulation in HD, the extent of use of glucose in the dialysate, and the supplementation of amino acids. View Full-Text
Keywords: malnutrition; lipids; lipase; heparin; dialysis; hemodialysis; peritoneal dialysis; glycation end products; glucose malnutrition; lipids; lipase; heparin; dialysis; hemodialysis; peritoneal dialysis; glycation end products; glucose
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Stegmayr, B. Dialysis Procedures Alter Metabolic Conditions. Nutrients 2017, 9, 548.

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