Total, free, and protein-bound sulphur amino acids in uraemic patients.

Abstract

Fasting plasma concentrations of sulphur amino acids (sAA) were measured in nine non-dialysed (ND) chronic uraemic patients on conservative treatment, 10 patients on continuous ambulatory peritoneal dialysis (CAPD), nine patients on haemodialysis (HD) treatment, and 10 healthy subjects (HS). Methionine and taurine concentrations were significantly decreased in the CAPD and HD patients and tended to be low in the ND patients. Cysteine sulphinic acid (CSA) levels were significantly higher in all patient groups. Total (t), free (f), and protein-bound (pb) homocysteine (Hcy) and cysteine (Cys) were significantly increased in all patient groups. Serine, a substrate for cystathionine synthesis from Hcy, showed significantly lower concentrations in all patient groups. The percentages of pbHcy were significantly higher in the CAPD and HD patients than in the ND patients (P < 0.0001, P = 0.002 respectively) or in the HS (P < 0.0001, P = 0.008 respectively), whereas the percentages of pbCys in CAPD and HD patients were significantly higher than in ND patients (P = 0.0006, P = 0.009 respectively) and tended to be high without reaching statistical significance compared to the HS. A single HD treatment decreased tHcy by 26%, fHcy by 39%, and pbHcy by 22%, as well as tCys by 40%, fCys by 54%, and pbCys by 27%. The tHcy concentration, although decreased by HD treatment, remained higher than in HS, whereas tCys was normalized by the dialysis session. In addition, HD treatment significantly decreased the plasma concentrations of methionine, CSA, taurine, and serine. We conclude that, except for methionine and taurine, the plasma sAA in their different forms are markedly increased in dialysed and non-dialysed uraemic patients. The percentages of pbHcy and pbCys were significantly higher in dialysed than in ND uraemic patients. HD treatment can normalize the tCys concentration, and decrease the tHcy concentration but not normalize it. The observed hyperhomocysteineaemia and low taurine levels may contribute to the high incidence of cardiovascular disease in uraemic patients.