The influence of several factors that intervene in hemodialysis on serum levels of triglycerides and free fatty acids.
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Abstract:
The effect of the administration of heparin and glucose, in doses and sequence similar to those of hemodialysis, on serum free fatty acids and triglycerides, was studied in eight patients with chronic renal failure who had not undergone hemodialysis. The results are compared with the action exerted by hemodialysis on the same parameters. During hemodialysis, the values of triglycerides are not significantly different from those obtained at similar intervals after the administration of glucose and/or heparin, with the exception that the values obtained five hours after beginning hemodialysis are lower than those obtained five hours after the administration of glucose (P less than 0.005). The levels of free fatty acids obtained during hemodialysis are higher (P less than 0.005) than those found during the other tests. The possible origin of these high fatty acid values is discussed, and the possibility that they originate from the acetate in the dialysis liquid is suggested.Cite
1) Hemodialysis for 3-4 hrs with C-3500 without heparin infusion is possible. 2) Hemodialysis without heparin with C-3500 may be preferred for patients with active or potential bleeding. 3) Excessive clotting may occur when blood flow is less than 250 ml/min, blood transfusion is used during dialysis or dialysis is longer than 3.5-4 hrs.
Activated clotting time
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We investigated whether decreased responsiveness of the heart to physiological increases in fatty acid availability results in lipid accumulation and lipotoxic heart disease. Lean and obese Zucker rats were either fed ad libitum or fasted overnight. Fasting increased plasma nonesterified fatty acid levels in both lean and obese rats, although levels were greatest in obese rats regardless of nutritional status. Despite increased fatty acid availability, the mRNA transcript levels of peroxisome proliferator-activated receptor (PPAR)-α-regulated genes were similar in fed lean and fed obese rat hearts. Fasting increased expression of all PPAR-α -regulated genes in lean Zucker rat hearts, whereas, in obese Zucker rat hearts, muscle carnitine palmitoyltransferase and medium-chain acyl-CoA dehydrogenase were unaltered with fasting. Rates of oleate oxidation were similar for hearts from fed rats. However, fasting increased rates of oleate oxidation only in hearts from lean rats. Dramatic lipid deposition occurred within cardiomyocytes of obese, but not lean, Zucker rats upon fasting. Cardiac output was significantly depressed in hearts isolated from obese rats compared with lean rats, regardless of nutritional status. Fasting increased cardiac output in hearts of lean rats only. Thus, the heart’s inability to increase fatty acid oxidation in proportion to increased fatty acid availability is associated with lipid accumulation and contractile dysfunction of the obese Zucker rat.
Carnitine O-palmitoyltransferase
Carnitine palmitoyltransferase I
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The heparin concentrations at the end of dialysis and the post-dialysis hemostasis were studied in 16 patients in a chronic hemodialysis program. In 8 of the patients, the heparin half-life values after dialysis were determined as well. The heparin doses were calculated as 90 IU/kg body-weight, administered in a standardized way. The heparin concentrations and the half-life values varied between 0.12-0.94 IU/ml and 29-114 minutes respectively, indicating that the heparin administration must be individually modelled. The hemostasis, measured by the arterial pressure times, was positively correlated to the heparin concentrations. Heparin levels less than 0.3 IU/ml were regularly associated with pressure times less than 10 minutes and no remaining heparin activity two hours after dialysis. In order to minimize the risk of both bleeding and clotting complications at the end of and after dialysis, a heparin concentration of approximately 0.25 IU/ml should be aimed for.
Activated clotting time
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Objective:To define the clinically relevant consequences of heparin-free hemodialysis(hfHD).Methods:Two groups of hemodialysis treatments were performed,one group with 500 patients was performed with heparin,and the another group with 500 patients was performed as hfHD.Prescribed and delivered Kt/V and dialysis efficiency were calculated respectively.Results:The prescribed Kt/V was 1.73±0.28 for standard hemodialysis with heparin vs.1.64±0.34 for hfHD(P0.05).The delivered Kt/V was 1.41±0.30 vs.1.34±0.36(P0.05).Efficiency was 0.80±0.13 vs.0.78±0.18(P0.05).Conclusion:The properly modified hfHD technique does not compromise delivery of dialysis.Increased treatment time is not necessary.
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One of the most effective measures in increasing the dialysis adequacy is to use an appropriate administration method of anticoagulants to prevent clot formation in the hemodialysis system. Therefore, the present research was carried out to find the most proper anticoagulation method in hemodialysis patients. 176 hemodialysis patients admitted to the dialysis centers of Kermanshah University of Medical Sciences under the two methods of anticoagulation with heparin (continuous infusion and interm
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Objective
To explore the clinical effect of hemodialysis without heparin in hemodialysis patients with cerebral hemorrhage.
Methods
A total of 48 hemodialysis patients with cerebral hemorrhage who were admitted to our hospital from March 2016 to March 2018 were selected and divided into a control group (n=24) and an observation group (n=24), and low-dose low-molecular-weight heparin and no heparin dialysis were given. Serum cTnT and UA results, dialysis costs, survival rates and complications were compared between the two groups.
Results
After hemodialysis, serum cTnT and UA levels in the observation group were significantly lower than those in the control group (P 0.05). Complications and survival of the observation group was significantly better than the control group (P<0.05).
Conclusion
There is no significant difference between the daily average dialysis cost and the low-dose low-molecular-weight heparin dialysis treatment for hemodialysis patients with intracerebral hemorrhage, and heparin-free dialysis is safe and effective.
Key words:
Heparin-free dialysis; Low molecular weight heparin; Hemodialysis; Cerebral hemorrhage
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Parametrial adipose- tissue taken from rats adrenalectomized 8 hours utilized more glucose and released less fatty acid than did tissue from normals; treatment with dexamethasone restored these values to normal. Although the fatty acid release in vitro was 10-fold greater in rats given growth hormone and glucocorticoid, plasma free fatty acids and ketone bodies were the same as those in rats given either hormone alone.
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Fatty acid synthesis
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Abnormalities of carbohydrate and fat metabolism in hypo- and hyperthyroidism were studied in 17 hyperthyroid and 7 hypothyroid patients in response to intramuscularly administered glucagon. Plasma glucose, insulin and free fatty acid levels were measured at intervals for 120 min after the injection of glucagon. Hyperthyroid patients showed a diminished glycogenolytic response and relatively poor insulin release. Free fatty acid concentrations promptly fell, while plasma insulin and glucose values rose. When a second dose of glucagon was given to these patients at 120 min, the glycogenolytic response was further decreased and free fatty acid levels now rose. Hypothyroid patients had a slow but supernormal rise in plasma glucose values after the injection of glucagon, but a diminished disappearance rate of glucose despite high levels of plasma insulin. Plasma free fatty acid concentrations rose concomitantly with glucose, and insulin levels did not fall below fasting values until 120 min following glucagon administration. Patients from both groups were retested when they had become euthyroid after treatment. Abnormal glucose, insulin and free fatty acid responses were no longer found.
Carbohydrate Metabolism
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We studied the effects of fatty acid oxidation on insulin secretion of db/db mice and underlying molecular mechanisms of these effects. At 2–3 months of age, db/db mice were markedly obese, hyperglycemic, and hyperinsulinemic. Serum free fatty acid (FFA) levels were increased in 2-month-old (1.5 ± 0.1 vs. 1.1 ± 0.1 mmol/l, P < 0.05) and 3-month-old (1.9 ± 0.1 vs. 1.2 ± 0.1 mmol/l, P < 0.01) mice compared with the age and sex-matched db/+ mice serving as controls. Glucose-induced insulin release from db/db islets was markedly decreased compared with that from db/+ islets and was specifically ameliorated (by 54% in 2-month-old and 38% in 3-month-old mice) by exposure to a carnitine palmitoyltransferase I inhibitor, etomoxir (1 μmol/l). Etomoxir failed to affect the insulin response to α-ketoisocaproate. The effect of etomoxir on glucose-induced insulin release was lost after culturing db/db islets in RPMI medium containing 22 mmol/l glucose but no fatty acid. Culture of db/+ islets with 0.125 mmol/l palmitate led to a decrease in glucose-induced insulin secretion, which was partially reversible by etomoxir. Both islet glucose oxidation and the ratio of glucose oxidation to utilization were decreased in db/db islets. Etomoxir significantly enhanced glucose oxidation by 60% and also the ratio of oxidation to glucose utilization (from 27 ± 2.5 to 37 ±3.0%, P < 0.05). Pyruvate dehydrogenase (PDH) activity was decreased in islets of db/db mice (75 ±4.2 vs. 91 ± 2.9 nU/ng DNA, P < 0.01), whereas PDH kinase activity was increased (rate of PDH inactivation −0.25 ± 0.02 vs. −0.11 ± 0.02/min, P < 0.01). These abnormalities were partly but not wholly reversed by a 2-h preexposure to etomoxir. In conclusion, elevated FFA levels in the db/db mouse diminish glucose-induced insulin secretion by a glucose–fatty acid cycle in which fatty acid oxidation inhibits glucose oxidation by decreasing PDH activity and increasing PDH kinase activities.
Carnitine palmitoyltransferase I
Carbohydrate Metabolism
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In ten patients treated by maintenance hemodialysis due to end-stage renal failure evaluation of dialysis efficiency was performed during the treatment with heparin alone as well as in the course of prostacyclin -heparin infusion. Statistically significant lower level of urea at the end of dialysis and significantly higher urea clearance were found during hemodialysis with prostacyclin -heparin infusion in comparison with infusion of heparin alone.
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