Bober Joanna, Kedzierska Karolina, Safranow Krzysztof, Kwiatkowska Ewa, Jakubowska Katarzyna, Herdzik Edyta, Dołegowska Barbara, Domański Leszek, Ciechanowski Kazimierz
Department of Biochemistry and Chemistry, Pomeranian Medical University, Szczecin, Poland.
Nephron Clin Pract. 2003;95(1):c31-6. doi: 10.1159/000073016.
In chronic renal failure the accumulation of some purine nucleotides (in erythrocytes) develops both in patients undergoing conservative treatment and in hemodialyzed patients. The aim of the study was: (1) To find if hemodialysis (HD) sessions using dialyzing fluid containing glucose leads to an increase in ATP concentration and changes in the concentration of other nucleotides, nucleosides and oxypurines in erythrocytes. The potential consequence of such purine concentration changes is the increase of 2,3-DPG concentration and an improved transportation of oxygen in erythrocytes which are more resistant to hemolysis. (2) To compare blood concentrations of purine nucleotides, nucleosides and oxypurines in patients undergoing chronic HD with dialyzing fluid containing or lacking glucose. Significant differences could suggest the long-term influence of glucose in dialyzing fluid on erythrocyte energetic state.
Whole blood nucleotide concentrations were evaluated with the use of a high-performance liquid chromatography technique.
Before the HD session the patients in the 'plus glucose' group had significantly higher concentrations of ATP, ADP, AMP, TAN, NAD, NADP, GTP + GDP, GMP, Urd and HYP than patients in the 'no glucose' group. After the HD the patients in the 'plus glucose' group had significantly higher concentrations of ADP, AMP, TAN, NAD, NADP, Urd and HYP than in the 'no glucose' group. Both before and after the HD session, the uric acid concentrations and AEC were significantly lower in the 'plus glucose' group than in the 'no glucose' group. A significant decrease in the whole blood hypoxanthine (p < 0.05) and uric acid (p < 0.001) concentrations after HD was found in the 'no glucose' group while a significant increase in ADP concentration (p < 0.05) was detected in the patients' erythrocytes in the 'plus glucose' group. In this group a significant decrease of GTP + GDP and GMP (p < 0.05), uric acid concentration (p < 0.001) and adenylate energy charge (p < 0.05) were observed after the dialysis. However, no significant differences in nucleotide concentrations before and after the HD were found in the 'no glucose' group.
The presence of glucose in the dialyzing fluid causes a significant modification of the energetic state of cells which is reflected by the purines' and their metabolites' concentrations in the erythrocytes. Higher ATP concentrations in patients with renal failure who have been dialyzed with the fluid containing glucose can be considered as an organism adaptation to a decreased amount of RBC and hemoglobin concentration.
在慢性肾衰竭患者中，无论是接受保守治疗的患者还是接受血液透析的患者，（红细胞中）一些嘌呤核苷酸都会蓄积。本研究的目的是：（1）探究使用含葡萄糖透析液进行血液透析（HD）治疗是否会导致红细胞中ATP浓度升高以及其他核苷酸、核苷和氧嘌呤浓度的变化。这种嘌呤浓度变化的潜在后果是2,3 - 二磷酸甘油酸（2,3 - DPG）浓度升高以及红细胞中氧运输改善，且红细胞对溶血更具抵抗力。（2）比较使用含葡萄糖或不含葡萄糖透析液进行慢性HD治疗的患者血液中嘌呤核苷酸、核苷和氧嘌呤的浓度。显著差异可能表明透析液中葡萄糖对红细胞能量状态的长期影响。
采用高效液相色谱技术评估全血核苷酸浓度。
HD治疗前，“加葡萄糖”组患者的ATP、ADP、AMP、总腺苷酸（TAN）、NAD、NADP、GTP + GDP、GMP、尿苷（Urd）和次黄嘌呤（HYP）浓度显著高于“无葡萄糖”组患者。HD治疗后，“加葡萄糖”组患者的ADP、AMP、TAN、NAD、NADP、Urd和HYP浓度显著高于“无葡萄糖”组。HD治疗前后，“加葡萄糖”组的尿酸浓度和腺苷能量电荷（AEC）均显著低于“无葡萄糖”组。“无葡萄糖”组HD治疗后全血次黄嘌呤浓度显著降低（p < 0.05），尿酸浓度显著降低（p < 0.001）；而“加葡萄糖”组患者红细胞中的ADP浓度显著升高（p < 0.05）。在该组中，透析后观察到GTP + GDP、GMP浓度显著降低（p < 0.05），尿酸浓度显著降低（p < 0.001），腺苷酸能量电荷显著降低（p < 0.05）。然而，“无葡萄糖”组HD治疗前后核苷酸浓度无显著差异。
透析液中葡萄糖的存在会导致细胞能量状态发生显著改变，这可通过红细胞中嘌呤及其代谢产物的浓度反映出来。对于使用含葡萄糖透析液进行透析的肾衰竭患者，较高的ATP浓度可被视为机体对红细胞数量减少和血红蛋白浓度降低的一种适应。
