Metabolites of glucose in the blood of patients with renal failure.

The blood concentrations of pyruvate and of some of its metabolites and the red cell 2,3-diphosphoglycerate concentration were compared with the severity of uraemia in 103 patients with renal failure. In chronic renal failure 2,3-butylene glycol was distinctly elevated, and a positive linear correlation (2p Less Than 0.001) with the urea was found. The values were even higher in corresponding patients with uraemic pericarditis, but,--taking into account their relation to the urea--,they were not elevated in acute renal failure. Acetaldehyde, acetoin and acetate behaved in part likewise. Severe uraemia, which clinically was demonstrated by uraemic pericarditis, was characterized biochemically, without regard to the urea, by very elevated values of 2,3-butylene glycol and acetaldehyde and of the pyruvate: lactate ratio. In addition, the chronic patients who were not undergoing regular haemodialysis, did not show the expected rise of 2,3-diphospho-glycerate along with progressive anaemia. The data suggest that the uraemic state is characterized by the impairment of the oxidative glucose metabolism between pyruvate and the tricarbonic acid cycle more precisely than by the blood urea.