Plasma glucose turnover and oxidation during hemodialysis: nutritional effect of dialysis fluid

Abstract

Mass transfer of glucose from dialysis fluid into patients is a source of energy and a form of nutrition during hemodialysis. The effect of glucose mass transfer on endogenous glucose metabolism and the overall nutritional importance of glucose transfer is not known. Rates of plasma glucose turnover and oxidation were determined by radioisotope-dilution techniques in patients with chronic renal failure (CRF) in the basal state, during hemodialysis, and during the infusion of glucose at a rate similar to the mass transfer rate (Mt: 6.6 +/- 0.7 mumol.min-1.kg-1). Rates of plasma glucose turnover (11.8 +/- 0.8 mumol.min-1.kg-1) and oxidation (4.0 +/- 0.4 mumol.min-1.kg-1) and contribution of glucose oxidation to the metabolic rate were similar to those of control subjects both in the basal state and during glucose infusion. During hemodialysis with acetate and glucose, the plasma glucose turnover rate was similar to that in the basal state, but the energy from glucose oxidation was less (P < or = 0.02) even though energy expenditure was increased by 21%. Immediate oxidation of plasma glucose and acetate accounted for 65% of the patients' energy expenditure. Energy (1172 kJ) from acetate Mt and glucose Mt surpassed the patients' energy requirements, offsetting the utilization of endogenous fuels, a sparing effect equivalent to 31 g fat or 70 g carbohydrate. Rates of plasma glucose turnover and oxidation during bicarbonate-glucose and glucose-free acetate hemodialysis were similar to that during acetate-glucose hemodialysis. However, without glucose or acetate in the bath fluid, a deficit as much as 669 kJ must be met by the oxidation of endogenous fuels. Addition of organic nutrients that supply energy to dialysis fluids may over time be a beneficial supplemental treatment for the malnutrition and body wasting commonly observed in CRF.