Coordinated increase in albumin, fibrinogen, and muscle protein synthesis during hemodialysis: role of cytokines

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Abstract
Serum albumin, fibrinogen levels, and lean body mass are important predictors of outcome in end-stage renal disease (ESRD). We estimated the fractional synthesis rates of albumin (FSR-A), fibrinogen (FSR-F), and muscle protein (FSR-M) in nine ESRD patients and eight controls, using primed constant infusion of l-[ ring-13C6]phenylalanine. Cytokine profile and arteriovenous balance of amino acids were also measured. ESRD patients were studied before (Pre-HD) and during hemodialysis (HD). Plasma IL-6, IL-10, and C-reactive protein increased significantly during HD. Despite a decrease in the delivery of amino acids to the leg, the outflow of the amino acids increased during HD. The net balance of amino acids became more negative during HD, indicating release from the muscle. HD increased leg muscle protein synthesis (45%) and catabolism (108%) but decreased whole body proteolysis (15%). FSR-A during HD (9.7 ± 0.9%/day) was higher than pre-HD (6.5 ± 0.9%/day) and controls (5.8 ± 0.5%/day, P < 0.01). FSR-F increased during HD (19.7 ± 2.6%/day vs. 11.8 ± 0.6%/day, P < 0.01), but it was not significantly different from that of controls (14.4 ± 1.4%/day). FSR-M intradialysis (1.77 ± 0.19%/day) was higher than pre-HD (1.21 ± 0.25%/day) and controls (1.30 ± 0.32%/day, P < 0.001). Pre-HD FSR-A, FSR-F, and FSR-M values were comparable to those of controls. There was a significant and positive correlation between plasma IL-6 and the FSRs. Thus, in ESRD patients without metabolic acidosis, the fractional synthesis rates of albumin, fibrinogen, and muscle protein are not decreased pre-HD. However, HD increases the synthesis of albumin, fibrinogen, and muscle protein. The coordinated increase in the FSRs is facilitated by constant delivery of amino acids derived from the muscle catabolism and intradialytic increase in IL-6.