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Abstract: TH-PO312

Fatigue on Hemodialysis Day Is Associated with Post-Hemodialysis Amino Acids Depletion

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Debnath, Subrata, University of Texas Health San Anotonio, San Antonio, Texas, United States
  • O'Connor, Jason, University of Texas Health San Antonio, San Antonio, Texas, United States
  • Bansal, Shweta, University of Texas Health San Antonio, San Antonio, Texas, United States
  • Lorenzo, Carlos, University of Texas Health San Antonio, San Antonio, Texas, United States
  • Sharma, Kumar, University of Texas Health San Antonio, San Antonio, Texas, United States
Background

End-stage renal disease (ESRD) patients on maintenance hemodialysis (HD) endure debilitating fatigue. Kidney function is essential for the synthesis, balance, and interorgan exchange of several amino acids (AA) notably aromatic amino acids (AAA) such as phenylalanine, tyrosine, and tryptophan and branched-chain amino acids (BCAA): leucine, isoleucine and valine. Dysregulation of these AA has been implicated in the genesis of fatigue as they may affect neurotransmitters. The relationship of AA with fatigue in HD patients is not known.

Methods

In a cross-sectional study, we examined the relationship between AA and fatigue in a well-characterized cohort of HD patients with T2 diabetes (N=119). The mean±SD age was 54.77±12.76 yr and 48% were female. Mean serum albumin was 3.46±0.38 g/dl, Hgb 11.04±1.43 mg/dl, and HgbA1c 6.93±1.86%. Fatigue on HD day was assessed by the 9-item Brief Fatigue Inventory (BFI) which measures fatigue severity and fatigue impact on daily functioning. BFI has internal consistency coefficient 0.96 and scores range from 0 to 90, lower score = less fatigue. BFI item #3 (Please rate your fatigue that best describes your WORST level of fatigue) was chosen to represent fatigue severity for conceptual simplicity. Free AA in pre- and post-HD plasma were quantified using HPLC-mass spectrometry.

Results

BCAA and AAA levels decreased significantly post HD (p<0.0001 and 0.0009, respectively). Post-HD AA, except for tyrosine, correlated with BFI item #3 and global fatigue scores (mean of all BFI 9 items). On Pearson correlation, post-HD BCAA and AAA levels correlated negatively with worst fatigue (r=−0.24, p=0.015 and r=−0.26, p=0.009, respectively) and global fatigue (r=−0.26, p=0.008 and r=−0.26, p=0.01, respectively). These correlations remained significant after adjustments for HD duration, dialysis shift, and intradialytic changes in body weight and blood pressure. Fatigue intensity, categorized into mild (1-3), moderate (4-6), and severe (≥7) based on BFI item #3 score, inversely related to post-HD AA levels: BCAA (p for trend 0.028) and AAA (p for trend 0.008).

Conclusion

HD procedure depletes BCAA and AAA. Post-HD levels of both BCAA and AAA correlate with fatigue on HD day in ESRD patients. Depleted AA may contribute to impaired neurotransmitters synthesis.

Funding

  • Private Foundation Support