Abstract
BackgroundAn association of higher levels of β-hydroxybutyrate (β-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/β-HB), a relevant marker of energy state, in HD patients.MethodsThe levels of arterial AcAc and β-HB, and AcAc/β-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 β-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/β-HB ratio seen in those with DM. Although the arterial AcAc/β-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 β-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 β-HB, and log AcAc/β-HB ratio as independent variables, revealed an independent and significant association of log AcAc/ β-HB ratio, but not log β-HB, with serum albumin and uric acid.ConclusionWe found that a decreased AcAc/β-HB ratio resulting from increased β-HB, but not increased β-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/β-HB ratio.
Highlights
An association of higher levels of β-hydroxybutyrate (β-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported
It has been shown that a reduction in arterial ketone body ratio, defined by determining arterial AcAc/β-HB ratio, a non-invasive method for evaluating hepatic energy charge [5], is a novel independent cardiovascular disease (CVD) risk factor [6], it is important to examine whether higher β-HB by itself or a reduction in arterial AcAc/β-HB ratio resulting from higher β-HB as well function to contribute to worse outcome of HD patients
Because of the effect of insulin to suppress production of arterial ketone bodies [7], it is possible that stimulation of ketone body production resulting from inhibition of insulin secretion in patients treated with dialysate containing 125 mg/dL glucose might differ between those with type 2 diabetes mellitus (T2DM) and non-DM HD patients
Summary
An association of higher levels of β-hydroxybutyrate (β-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. Patients undergoing hemodialysis (HD) are known to exhibit a significant increase in serum ketone bodies [acetoacetate (AcAc), β-hydroxybutyrate (β-HB)] during a single HD session [1]. It was recently reported that higher serum β-HB was independently associated with increased cardiovascular disease (CVD) events and cases of all-cause death in HD patients in Japan [4]. It has been shown that a reduction in arterial ketone body ratio, defined by determining arterial AcAc/β-HB ratio, a non-invasive method for evaluating hepatic energy charge [5], is a novel independent CVD risk factor [6], it is important to examine whether higher β-HB by itself or a reduction in arterial AcAc/β-HB ratio resulting from higher β-HB as well function to contribute to worse outcome of HD patients. Because of the effect of insulin to suppress production of arterial ketone bodies [7], it is possible that stimulation of ketone body production resulting from inhibition of insulin secretion in patients treated with dialysate containing 125 mg/dL glucose might differ between those with type 2 diabetes mellitus (T2DM) and non-DM HD patients
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