Coordinated increase in albumin, fibrinogen, and muscle protein synthesis during hemodialysis: role of cytokines

Raj, Dominic S.; Dominic, Elizabeth A.; Wolfe, Robert R.; Shah, Vallabh O.; Bankhurst, Arthur D.; Zager, Philip G.; Ferrando, Arny A.

doi:10.1152/ajpendo.00444.2003

Cited by 47 publications

(46 citation statements)

References 39 publications

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“…Thus, multiple factors contribute to the inflammatory state in CKD. Synthesis of acute phase proteins is regulated by cytokines released from the site of injury (36). We found that the CRP and fibrinogen levels increased across the spectrum of renal function studied.…”

Section: Discussionmentioning

confidence: 74%

See 1 more Smart Citation

Association between Albuminuria, Kidney Function, and Inflammatory Biomarker Profile in CKD in CRIC

Gupta

Mitra

Kanetsky

et al. 2012

Clinical Journal of the American Society of Nephrology

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Section: Discussionmentioning

confidence: 74%

“…UACR was positively related to fibrinogen, IL-6, and TNF-a and negatively with serum albumin. While it is possible that proinflammatory cytokines may be pathogenically involved in promoting proteinuria, it is also possible that albuminuria selectively activates cytokines that drives hepatic albumin and fibrinogen synthesis (36).…”

Section: Discussionmentioning

confidence: 99%

Association between Albuminuria, Kidney Function, and Inflammatory Biomarker Profile in CKD in CRIC

Gupta

Mitra

Kanetsky

et al. 2012

Clinical Journal of the American Society of Nephrology

Self Cite

469

344

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“…In this method, the isotopes are detached from the infused amino acids and subsequently incorporated into new protein molecules. Raj et al (9) reported that fractional synthesis rates, %/d, of albumin and fibrinogen increase by 49 and 67%, respectively, during HD. Caglar et al (20) reported that in eight ESRD patients, fractional synthesis rates of albumin and fibrinogen increased by 65 and 35%, respectively, during HD.…”

Section: Hd Is Protein-catabolic: a Discussionmentioning

confidence: 99%

“…In a similar study, Raj et al (9) measured leg kinetics (nmol/100 ml per min) using 13 C 6 phenylalanine and reported a 104 and 40% rise in protein degradation and synthesis, respectively, during HD. This resulted in a 93% reduction in net protein balance.…”

Section: Regional Kinetics Across the Forearm Or Legmentioning

confidence: 94%

Does Hemodialysis Increase Protein Breakdown? Dissociation between Whole-Body Amino Acid Turnover and Regional Muscle Kinetics

Lim¹,

İkizler²,

Raj³

et al. 2005

Journal of the American Society of Nephrology

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Hemodialysis (HD) is a protein catabolic procedure. Whole-body amino acid turnover studies identify dialysate amino acid loss and reduced protein synthesis as the catabolic events; proteolysis is not increased. Regional amino acid kinetics, however, document enhanced muscle protein breakdown as the cause of the catabolism; muscle protein synthesis also increased but to a lesser magnitude than the increment in protein breakdown. This discordance between whole-body and regional kinetics is best explained by the contrasting physiology between the muscle and the liver. During HD, muscle releases amino acids, which then are taken up by the liver for de novo protein synthesis. There seems to be a somatic to visceral recycling of amino acids. Evidence supporting this concept includes the increased fractional synthesis of albumin and fibrinogen during HD. It should be emphasized that region-or organ-specific kinetics vary, and whole-body turnover is a composite of all of the visceral and somatic compartments taken together. Reduced whole-body protein synthesis may be a compensatory adaptation to dialysate amino acid loss with a consequent reduction in plasma amino acid concentration. Notwithstanding the protein catabolic nature of HD, evidence is accumulating that intradialytic nutritional supplementation may blunt its catabolic effect. U ntil recently, uremia was believed to be a protein catabolic state. This view is no longer tenable because numerous whole-body amino acid turnover studies have unequivocally revealed that there is no excess protein catabolism in the chronic renal failure population in the absence of acidosis and/or concomitant illnesses (1). Uremic patients respond to low-protein diets with appropriate downregulation of whole-body proteolysis (2,3). Peritoneal dialysis is protein catabolic primarily because of protein and amino acid losses through the peritoneal effluent (4). The remaining unsettled issue is whether hemodialysis (HD) induces protein catabolism and, if it does, by what mechanism. There are theoretical reasons to believe that HD can augment protein catabolism. These include amino acid loss to the dialysate and cytokinemediated proteolysis as a result of exposure to bio-incompatible membrane and endotoxin-contaminated dialysate, but to date, investigation of protein metabolism using different techniques has yielded conflicting results. J Am Soc Nephrol Protein Metabolism during HD: A Review of the LiteratureThis article reviews the available literature of protein metabolism during HD and proposes a unifying hypothesis to explain the discordant results and diverging conclusions. The work cited in this review is categorized according to the technique used. Nitrogen Balance Combined with Urea KineticsThe seminal findings of Borah et al. (5) that nitrogen balance is always more negative or less positive, depending on the intake, on dialysis days compared with nondialysis days greatly influenced the belief that HD is a protein catabolic procedure. Lim et al. (6) also reported that nitrogen ou...

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“…Caglar et al reported that fractional synthesis rates of albumin and fibrinogen, along with production of IL-6, increased during hemodialysis and even beyond 2 hours after the hemodialysis period, indicating that the hemodialysis procedure itself is an inflammatory trigger for MHD patients (1). In a pilot study, Raj et al reported that there was a positive correlation between plasma IL-6 levels and fractional synthesis rates of skeletal muscle during hemodialysis and concluded that the organized increase in the fractional synthesis rates is related to triggered inflammation by hemodialysis (15). Similarly, Garibotto et al showed that higher release of IL-6 by the skeletal muscle leads to higher phenylalanine release 15 MHD patients (16).…”

Section: L I N I C a L M E D I C I N Ementioning

confidence: 99%

Systemic inflammation is associated with exaggerated skeletal muscle protein catabolism in maintenance hemodialysis patients

Değer¹,

Hung²,

Gamboa³

et al. 2017

JCI Insight

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Coordinated increase in albumin, fibrinogen, and muscle protein synthesis during hemodialysis: role of cytokines

Abstract: Ferrando. Coordinated increase in albumin, fibrinogen, and muscle protein synthesis during hemodialysis: role of cytokines. Am J Physiol

Cited by 47 publications

References 39 publications

Association between Albuminuria, Kidney Function, and Inflammatory Biomarker Profile in CKD in CRIC

Association between Albuminuria, Kidney Function, and Inflammatory Biomarker Profile in CKD in CRIC

Does Hemodialysis Increase Protein Breakdown? Dissociation between Whole-Body Amino Acid Turnover and Regional Muscle Kinetics

Systemic inflammation is associated with exaggerated skeletal muscle protein catabolism in maintenance hemodialysis patients

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