Removal of uremic retention products by hemodialysis is coupled with indiscriminate loss of vital metabolites
Removal of uremic retention products by hemodialysis is coupled with indiscriminate loss of vital metabolites
复制标题
通过血液透析去除尿毒症潴留产物伴随着重要代谢物的不加选择的损失
DOI：
10.1016/j.clinbiochem.2017.09.012
复制
发表时间：
2017-12-01
影响因子：
2.8
通讯作者：
Vaziri, Nosratola D.
中科院分区：
文献类型：
--
作者：
Zhang, Zhi-Hao;Mao, Jia-Rong;Vaziri, Nosratola D.
背景：虽然透析改善了尿毒症和水电解质紊乱，但透析人群的年死亡率仍然很高，这反映了它在替代肾功能方面的不足。与正常肾脏不同，透析会导致体液的体积和成分发生戏剧性的变化，并不分青红皂白地清除重要的溶质。为探讨血液透析对终末期肾病(ESRD)患者血浆代谢产物的影响。方法：选择80例血液透析患者和80例年龄/性别匹配的健康对照组。结果：主成分分析显示ESRD患者透析前血浆中214种代谢物浓度显著高于ESRD组(ESRD组126例升高，ESRD组88例降低)。比较透析后和透析前的数据，发现362种代谢物发生了显著变化。血液透析后ESI+代谢物中195例减少，55例增加，ESI代谢物中82例减少，30例增加。通过透析器的单一血液通道导致323种代谢物发生显著变化。将终末期肾病患者血液透析后的数据与健康受试者的数据进行比较，发现其代谢特征有显著差异。我们鉴定了362种差异代谢物中的55种，包括已知的尿毒症毒素、废物和重要的生物化合物。结论：除了尿毒症毒素和废物外，血液透析还可以去除大量已识别和尚未识别的代谢物。透析导致的重要生物化合物的耗尽可能导致该人群的高发病率和年死亡率。
Background: Although dialysis ameliorates uremia and fluid and electrolytes disorders, annual mortality rate remains high in dialysis population reflecting its shortcoming in replacing renal function. Unlike the normal kidney, dialysis causes dramatic shifts in volume and composition of body fluids and indiscriminate removal of vital solutes. Present study was undertaken to determine the impact of hemodialysis on plasma metabolites in end-stage renal disease (ESRD) patients.Methods: 80 hemodialysis patients and 80 age/gender-matched healthy controls were enrolled in the study. Using ultra performance liquid chromatography-high-definition mass spectrometry, we measured plasma metabolites before, during, and after hemodialysis procedure and in blood entering and leaving the dialysis filter.Results: Principal component analysis revealed significant difference in concentration of 214 metabolites between healthy control and ESRD patients' pre-dialysis plasma (126 increased and 88 reduced in ESRD group). Comparison of post-dialysis with pre-dialysis data revealed significant changes in the 362 metabolites. Among ESI+ metabolites 195 decreased and 55 increased and among ESI- metabolites 82 decreased and 30 increased following hemodialysis. Single blood passage through the dialyzer caused significant changes in 323 metabolites. Comparison of ESRD patients' post-hemodialysis with healthy subjects' data revealed marked differences in metabolic profiles. We identified 55 of the 362 differential metabolites including well known uremic toxins, waste products and vital biological compounds.Conclusion: In addition to uremic toxins and waste products hemodialysis removes large number of identified and as-yet un-identified metabolites. Depletion of vital biological compounds by dialysis may contribute to the high morbidity and annual mortality rate in this population.