Skutches C L, Sigler M H, Teehan B P, Cooper J H, Reichard G A
Kidney Int. 1983 Jan;23(1):57-63. doi: 10.1038/ki.1983.11.
During hemodialysis large amounts of acetate enter the bloodstream. Generally, it is assumed that this exogenous acetate load is oxidized immediately to carbon dioxide and water; however, the rate of plasma acetate oxidation and the effect of acetate oxidation on energy metabolism during hemodialysis has not been determined previously. The rates of plasma acetate turnover and oxidation were determined during hemodialysis in seven chronic renal failure patients by the primed continuous infusion of [1-14C] acetate. The plasma acetate turnover rate (57.2 +/- 2.9 mumoles/min X kg) agreed closely with the mass transfer rate of dialysate acetate into the bloodstream (55.3 +/- 3.2 mumoles/min X kg). Of the acetate entering the bloodstream, 54.5 +/- 5.2% or 31.6 +/- 3.77 mumoles/min X kg was oxidized immediately accounting for 40.3 +/- 4.8% of the patient's caloric expenditure. Although the oxidation of acetate during dialysis supplied a major portion of the patient's caloric need, a significant quantity of acetate was eliminated by pathways other than direct oxidation. An average overall respiratory quotient (RQ) of 1.0 +/- 0.02 indicated that fat oxidation was spared to maintain energy homeostasis during hemodialysis. The calculated non-protein RQ exceeded unity suggesting that net fat synthesis actually occurred.
在血液透析过程中，大量醋酸盐进入血液。一般认为，这种外源性醋酸盐负荷会立即被氧化为二氧化碳和水；然而，血液透析过程中血浆醋酸盐的氧化速率以及醋酸盐氧化对能量代谢的影响此前尚未确定。通过对7名慢性肾衰竭患者进行[1-¹⁴C]醋酸盐的单次持续输注，测定了血液透析期间血浆醋酸盐的周转和氧化速率。血浆醋酸盐周转速率（57.2±2.9微摩尔/分钟·千克）与透析液醋酸盐进入血液的传质速率（55.3±3.2微摩尔/分钟·千克）非常接近。进入血液的醋酸盐中，54.5±5.2%或31.6±3.77微摩尔/分钟·千克立即被氧化，占患者热量消耗的40.3±4.8%。尽管透析期间醋酸盐的氧化提供了患者大部分的热量需求，但大量醋酸盐通过直接氧化以外的途径被清除。平均总体呼吸商（RQ）为1.0±0.02，表明在血液透析期间脂肪氧化得以保留以维持能量稳态。计算得出的非蛋白呼吸商超过1，表明实际上发生了净脂肪合成。
