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Abstract: SA-OR54

Depletion of Plasma Aromatic Amino Acids During Hemodialysis Is Associated with Fatigue

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Debnath, Subrata, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Garcia, Jose M., The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Akula, Niklesh, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Sharma, Kumar, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Lorenzo, Carlos, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Background

The etiology of fatigue in hemodialysis (HD) patients remains elusive. Aromatic amino acids (AAA – tryptophan, phenylalanine, and tyrosine), the precursors of neurotransmitters serotonin, dopamine, and norepinephrine, are implicated in the pathogenesis of fatigue. A significant amount of AAA is lost during a dialysis. We examined the association of changes in AAA during a dialysis session with fatigue.

Methods

114 adult HD patients self-reported fatigue on a dialysis day using validated Brief Fatigue Inventory. Pre- and post-dialysis plasma AAA levels were measured by HPLC-mass spectrometry. Spearman correlation was used to assess the relationship between AAA levels and fatigue.

Results

Post-dialysis plasma levels of phenylalanine and tyrosine decreased significantly compared to the baseline pre-dialysis levels except for tryptophan (p <0.0001, 0.04, and 0.62, respectively). None of the pre-dialysis plasma levels of amino acids were associated with fatigue (p >0.05 for all correlations). Post-dialysis plasma levels of phenylalanine, tryptophan, and AAA correlated inversely with fatigue score (p <0.05 for all correlations). The relative decline (post – pre/pre values) in phenylalanine, tyrosine, and AAA levels during dialysis was positively correlated with fatigue score (p <0.05 for all correlations). Compared to the HD patients in the lowest tertile of fatigue score, those in the highest tertile had greater relative decline in plasma AAA levels between pre- and post-dialysis, p=0.045 (Figure).

Conclusion

Plasma AAA depletion during a dialysis session is associated with fatigue, suggesting possible neurotransmitters imbalance as a contributory factor. Future studies are warranted to explore the role of neurotransmitters to the pathogenesis of HD fatigue using functional MRI.