Routine Evaluation of Kt/V and Protein Catabolic Rate

Abstract Background Accumulation of middle-weight uraemic toxins in haemodialysis (HD) patients results in increased morbidity and mortality. Whether medium cut-off HD (MCO-HD) improves removal of middle-weight uraemic toxins remains to be demonstrated. Methods This cross-over prospective study included 40 patients randomly assigned to receive either 3 months of MCO-HD followed by 3 months of high-flux HD (HF-HD), or vice versa. The primary endpoint was myoglobin reduction ratio (RR) after 3 months of MCO-HD. Secondary endpoints were the effect of MCO-HD on other middle-weight toxins and protein-bound toxins, and on parameters of nutrition, inflammation, anaemia and oxidative stress. Results Compared with HF-HD, MCO-HD provided higher mean RR of myoglobin (36 ± 8 versus 57 ± 13%, P < 0.0001), beta2-microglobulin (68 ± 6 versus 73 ± 15%, P = 0.04), prolactin (32 ± 13 versus 59 ± 11%, P < 0.0001), fibroblast growth factor 23 (20 ± 21 versus 41 ± 22%, P = 0.0002), homocysteine (43 ± 7 versus 46 ± 9%, P = 0.03) and higher median RR of kappa [54 (48–58) versus 70 (63–74)%, P < 0.0001] and lambda free light chain (FLC) [15 (9–22) versus 44 (38–49)%, P < 0.0001]. Mean ± SD pre-dialysis levels of beta2-microglobulin (28.4 ± 5.6 versus 26.9 ± 5.1 mg/L, P = 0.01) and oxidized low-density lipoprote (6.9 ± 4.4 versus 5.5 ± 2.5 pg/mL, P = 0.04), and median (interquartile range) kappa FLC [145 (104–203) versus 129 (109–190) mg/L, P < 0.03] and lambda FLC [106 (77–132) versus 89 (62–125) mg/L, P = 0.002] were significantly lower. Mean albumin levels decreased significantly (38.2 ± 4.1 versus 36.9 ± 4.3 g/L, P = 0.004), without an effect on nutritional status as suggested by unchanged normalized protein catabolic rate and transthyretin level. Conclusions Compared with HF-HD, MCO-HD provides higher myoglobin and other middle molecules RR and is associated with moderate hypoalbuminemia. The potential benefits of this strategy on long-term clinical outcomes deserve further evaluation.

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Is the Correlation between the Normalised Protein Catabolic Rate (Npcr) and Kt/V the Result of Mathematical Coupling?

Clinical Science ◽

10.1042/cs086004pa ◽

1994 ◽

Vol 86 (s30) ◽

pp. 4P-4P ◽

Cited By ~ 3

Author(s):

J.C. Harty ◽

B Farragher ◽

H Boulton ◽

J Kirwell ◽

N Heelis ◽

...

Keyword(s):

Catabolic Rate ◽

Mathematical Coupling ◽

Protein Catabolic Rate

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Hematologic and Biochemical Indices in the East African Baboon

Blood ◽

10.1182/blood.v26.5.682.682 ◽

1965 ◽

Vol 26 (5) ◽

pp. 682-686 ◽

Cited By ~ 14

Author(s):

HENRY FOY ◽

ATHENA KONDI ◽

VERSTISTINE MBAYA

Keyword(s):

Serum Proteins ◽

Human Albumin ◽

Cell Uptake ◽

Red Cell ◽

East African ◽

Catabolic Rate ◽

Exchange Resins ◽

Biochemical Indices ◽

Marrow Activity ◽

Protein Catabolic Rate

Abstract Hematologic values for peripheral blood and marrow, serum proteins, B12 and folic acid levels are given for recently caught and captive baboons (P. anubis and P.sinocephalus) in Nairobi. The hemaglobin levels were higher in captive than in wild animals. There was no change in the serum proteins unless the animals were on a riboflavindeficient diet. Marrow activity as estimated by counting red cell precursors as a percentage of the total nucleated red cell population agreed with that of red cell uptake of Fe59 ferric chloride. Hemosiderin was present in the marrow in all the animals. Protein turnover studies using I131-labeled albumin with ion exchange resins indicated that the protein catabolic rate and turnover was high. This may have been due to the selective destruction of the human albumin in the baboon.

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