Effect of acetate on blood metabolites and glucose tolerance during haemodialysis in uraemic non-diabetic and diabetic subjects.

We examined changes in blood concentrations of glucose, acetate and other blood intermediary metabolites as well as the disposal of an intravenous glucose load during successive glucose-free acetate and control bicarbonate haemodialysis in random order, in non-diabetic and diabetic subjects. Plasma acetate levels increased about 10-fold in both the diabetic and non-diabetic subjects during the 1st hour of acetate dialysis. This was accompanied by about 5-fold increase in the levels of the ketone bodies-acetoacetate and 3-hydroxybutyrate. Ketone body levels did not change during bicarbonate dialysis. Additionally, the changes in blood levels of glucose, non-esterified fatty acids, pyruvate, lactate, glycerol and insulin were similar with either bicarbonate or acetate treatment in each subject group. The KG rate constant of glucose disposal after intravenous glucose (10 g/m2 body surface area) given after the 1st hour of a 5-hour haemodialysis was similarly unchanged with acetate or bicarbonate dialysis, despite the additional caloric load likely from the high blood levels of acetate obtained during acetate haemodialysis. We conclude that the major metabolic effect of acetate during haemodialysis is an increase in blood ketone body levels. Glucose utilisation, as assessed from the KG rate constant of glucose disposal or changes in blood lactate and pyruvate levels, was not affected by the high acetate levels attained during dialysis.