Influence of Glucose in Dialyzing Fluid on Purine Concentrations in Hemodialyzed Patients with Chronic Renal Failure

Abstract

Background: In chronic renal failure the accumulation of some purine nucleotides (in erythrocytes) develops both in patients undergoing conservative treatment and in hemodialyzed patients. The aim of the study was: (1) To find if hemodialysis (HD) sessions using dialyzing fluid containing glucose leads to an increase in ATP concentration and changes in the concentration of other nucleotides, nucleosides and oxypurines in erythrocytes. The potential consequence of such purine concentration changes is the increase of 2,3-DPG concentration and an improved transportation of oxygen in erythrocytes which are more resistant to hemolysis. (2) To compare blood concentrations of purine nucleotides, nucleosides and oxypurines in patients undergoing chronic HD with dialyzing fluid containing or lacking glucose. Significant differences could suggest the long-term influence of glucose in dialyzing fluid on erythrocyte energetic state. Methods: Whole blood nucleotide concentrations were evaluated with the use of a high-performance liquid chromatography technique. Results: Before the HD session the patients in the ‘plus glucose’ group had significantly higher concentrations of ATP, ADP, AMP, TAN, NAD, NADP, GTP + GDP, GMP, Urd and HYP than patients in the ‘no glucose’ group. After the HD the patients in the ‘plus glucose’ group had significantly higher concentrations of ADP, AMP, TAN, NAD, NADP, Urd and HYP than in the ‘no glucose’ group. Both before and after the HD session, the uric acid concentrations and AEC were significantly lower in the ‘plus glucose’ group than in the ‘no glucose’ group. A significant decrease in the whole blood hypoxanthine (p < 0.05) and uric acid (p < 0.001) concentrations after HD was found in the ‘no glucose’ group while a significant increase in ADP concentration (p < 0.05) was detected in the patients’ erythrocytes in the ‘plus glucose’ group. In this group a significant decrease of GTP + GDP and GMP (p < 0.05), uric acid concentration (p < 0.001) and adenylate energy charge (p < 0.05) were observed after the dialysis. However, no significant differences in nucleotide concentrations before and after the HD were found in the ‘no glucose’ group. Conclusion: The presence of glucose in the dialyzing fluid causes a significant modification of the energetic state of cells which is reflected by the purines’ and their metabolites’ concentrations in the erythrocytes. Higher ATP concentrations in patients with renal failure who have been dialyzed with the fluid containing glucose can be considered as an organism adaptation to a decreased amount of RBC and hemoglobin concentration.

Adenine, guanine and pyridine nucleotides in blood during physical exercise and restitution in healthy subjects

“…Chromatographic analysis was performed using a Hewlett-Packard series 1100 chromatograph according to the method used by Smolenski et al ( 1990 ), a modification of Bober et al ( 2003 ). The concentrations of nucleotides (ATP, ADP, AMP, IMP, GTP, GDP, GMP), Guo, Ino, Ado and Hyp were determined in the whole blood.…”

Haemodialysis-induced hypoglycaemia and glycaemic disarrays

“…Clinicians who treat nondiabetic patients on haemodialysis must be careful when using glucose-free dialysate because silent hypoglycaemia can occur; the glucose content of the haemodialysis solution is a major consideration in treatment. The addition of glucose to dialysate might help to maintain energy balance by decreasing the risk of hypoglycaemia and to limit oxidative stress by maintaining normal activity of the hexose monophosphate cycle in erythrocytes, which delivers free radical scavengers but does not reduce the negative effect of haemodialysis treatment on protein metabolism 22,23,30,31. Moreover, increasing extracellular osmolality by augmenting the dialysate sodium concentration decreases fluid loss to the intracellular compartment, leading to a reduced risk of dialysis-associated hypotension 10,14,32.…”