Association of higher arterial ketone body ratio (acetoacetate/β-hydroxybutyrate) with relevant nutritional marker in hemodialysis patients

BackgroundAn association of higher levels of beta -hydroxybutyrate (beta -HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/beta -HB), a relevant marker of energy state, in HD patients.MethodsThe levels of arterial AcAc and beta -HB, and AcAc/beta -HB ratio were determined in 49 HD patients just before undergoing an HD session. Additionally, changes in those levels during the session were examined to investigate their associations with clinical nutritional markers.ResultsArterial beta -HB, but not AcAc, was significantly higher at the baseline in 25 patients with type 2 diabetes mellitus (T2DM) as compared to 24 non-DM patients, with a significant reduction in arterial AcAc/beta -HB ratio seen in those with DM. Although the arterial AcAc/beta -HB ratio before the HD session was significantly higher in the non-DM group, it did not differ significantly after the session between the groups, indicating a faster rate of beta -HB disappearance from circulation in non-DM HD patients during the interdialytic period. Multiple regression analysis, which included age, gender, presence/absence of DM, log HD duration, log beta -HB, and log AcAc/beta -HB ratio as independent variables, revealed an independent and significant association of log AcAc/ beta -HB ratio, but not log beta -HB, with serum albumin and uric acid.ConclusionWe found that a decreased AcAc/beta -HB ratio resulting from increased beta -HB, but not increased beta -HB itself, was a significant factor independently associated with decreased levels of serum albumin and uric acid, known to be related to higher mortality in HD patients. Furthermore, it is possible that higher mortality in DM HD patients can be explained by reduced arterial AcAc/beta -HB ratio.