Amino acid and α-keto acid metabolism of long-term hemodialysis patients depends from oxygene availability

Hemodialysis (HD) patients show renal anemia and malnutrition. This is reflected by changed plasma amino acid levels. Our question was, how far malnutrition can be improved by rhEPO/iron supplementation therapy. Plasma levels of branched chain amino acids valine, leucine, isoleucine and their alpha-keto acids Served as markers for malnutrition. We compared plasma levels of 45 severe anemic HD patients (A) (Hb 7.2 +/- 0.8 [g/dl]), 34 partially corrected (B) (Hb 10.3 +/- 0.6 [g/dl]), 35 totally corrected (C) (Hb 13.5 +/- 0.7 [g/dl]) patients and 60 healthy control persons (N) (Hb 14.2 +/- 1.1 [g/dl]), determined by fluorescence HPLC. In correlation to the hemoglobin correction plasma levels were improved significantly (p < 0.05 - 0.01): valine (A/B/C/N): 130/146/155/205 (mu mol/l), leucine: 73/71/80/ 110 (mu mol/l) alpha-ketoisocaproate: 11.4/11.8/ 15.1/30.4 (mu mol/l). We conclude that improvement of energy metabolism follows so more, so better the correction of anemia happens. From this point of view we recommend the total correction of anemia in hemodialysis patients.