The Clinical Significance of tCO2 as a Marker of Nutritional Status in Stable Hemodialyzed Patients / 대한신장학회잡지

Metabolic acidosis is a well-recognized complication of chronic hemodialyzed patients. The metabolic acidosis in stable hemodialyzed patients is mainly resulted from the consequences of the inability to excrete nonvolatile acid and the patients daily protein intake. So severe metabolic acidosis in patients on hemodialysis is known as an independent determinant of protein catabolic rate and high mortality rate but the moderate degree of metabolic acidosis in stable patients on maintenace hemodialysis can be explained by the patients nutritional status. On the other hand, patients having adequate daily protein intake could have lower total CO2 levels than those of patients having inadequately lower daily protein intake. To identify this relationship, we analyzed correlations between pre-hemodialysis total CO2 and various factors reflecting the patient's nutritional status in 37 patients on stable hemodialysis. The total CO2 was ranged from 15.6 to 26.5mMol/L. Among various factors, total CO2 had negative linear correlation with normalized protein catabolic rate(nPCR) reflecting the patient's daily protein intake indirectly(Y= -0.0371X+1.75, r=-0.1319, P=0.014). Moreover, metabolic acidosis having CO2 lower than 18mMol/L may modulate protein kinetics as showing steeper slope than those of more than 18mMol/L(Y=-0.1321 X +3.342, r2=0.1074 vs Y=-0.03373X+1.7543 r2=0.1001, P=0.0001). However other factors including serum albumin, body mass index, pre-hemodialysis BUN, and Kt/V, had no correlation with the total CO2. The result suggested that moderately lower pre- hemodialysis total CO2 ranging from 18 to 26.5 mMol/L was usually resulted from the high intake of the patient's daily protein intake and should be of no concern in stable patients on maintenance hemodialysis and it may use as a parameter of nutritional status. However metabolic acidosis having CO2 lower than 18mMol/L may modulate protein-kinetics, which may make the protein catabolic rate increased and can not reflect the patient's nutritional status. But it should be recommended that further studies should be needed to confirm this factor.

nPCR as an Influencing Factor on rHuEPO Response / 대한신장학회잡지

Owing to the mass production of recombinant human erythropoietin(rHuEPO), anemia in hemodialysis patients is effectively treated by intravenous or subcutaneous injection of rHuEPO at each dialysis session. But considerable portion of patients being injected rHuEPO have the resistance of EPO treatment. The most common cause of EPO resistance is caused by functional and storage iron deficiency and followed by chronic inflammation, hyperparathyroidism and aluminum intoxication in its incidence. But the rHuEPO resistance is not fully explained by these causes. In the present study, the relationship between nPCR reflecting daily protein intake and the weekly doses of rHuEPO required to maintain hemoglobin levels at approximately 10gm/dL was analyzed in 34 hemodialysis patients All subjective patients of 34 hemodialysis were injected rHuEPO subcutaneously and divided into two group:Group A composing 22 hemodialysis patients is nPCR=1.0gm/kg/day. There were no significant differences in age, duration of hemodialysis, serum ferritin, serum iron, TIBC, transferrin saturation(%) of each group. The patients who had serum ferritin below 100 micro gm/dL or transferrin saturation(%) below 20% were excluded in this study. The weekly rHuEPO doses in patients with Group B was lower than those of patients with Group A(58.7627+/-20.465IU/kg/week vs 80.4317+/-38.6258IU/kg/week, P=0.041). Moreover Serum albumin levels in Group A were significantly lower than those of Group B(3.6522+/-0.4461gm/dL vs 4+/-0.3606gm/dL, P=0.031) and Kt/V in Group B were significantly higher than those of Group A (1.145+/-0.2049+/-1.4021+/-0.2981, P=0.021). Serum parathyroid hormone levels were significantly higher in Group A than those of Group B(171.9783+/-150.3378 pg/dL vs 72.8809+/-79.7226 pg/dL, P=0.049). But other various factors including serum aluminum, body mass index and acute phase reactant proteins such as C-reactive protein and ESR had no significant differences in each group. CONCLUSION: Our result showed that nPCR presenting daily protein intake is related with rHuEPO response and the patient's nutritional status. So we think that the nutrition aspect in EPO treatment should be considered. However, to prove this relationships completely between nutritional factors and rHuEPO response, further study shoud be needed.