Amino acid and alpha-keto acid metabolism depends on oxygen availability in chronic hemodialysis patients

Amino acid and alpha-keto acid metabolism depends on oxygen availability in chronic hemodialysis patients. Malnutrition in hemodialysis (HD) patients with renal anemia is reflected in an abnormal plasma amino acid profile. We wished to determine the extent to which malnutrition can be improved by co rrecting anemia with recombinant human erythropoietin (rhEPO) and supplemen tal iron. As specific parameters we measured and compared the plasma concen trations of the branched-chain amino acids valine, leucine and isoleucine a nd their transamination products - major participants in proteolysis and pr otein biosynthesis - using HPLC with fluorescence detection in 45 severely anemic HD patients (group a; Kb 7.2 +/- 0.8 g/dl), 34 patients with partial ly corrected anemia (group B: Kb 10.3 +/- 0.6 g/dl) and 35 HD patients with totally corrected anemia (group C: Kb 13.5 +/- 0.7 g/dl). Sixty healthy su bjects (group N: Hb 14.2 +/- 1.1 g/dl) sewed as controls. Correlating with the degree of correction (A/B/C/N), a significant shift to anabolic metabol ism was observed in the plasma levels of valine: 130/146/155/205 mu mol/l; leucine: 73/71/80/110 mu mol/l and alpha-ketoisocaproate (KIC): 11.4/11.8/1 5.1/30.4 mu mol/l. It is concluded that energy metabolism becomes increasin gly anabolic as hemoglobin levels are normalized.