Impact of hemodialysis on the abnormal glucose and alanine kinetics of chronic azotemia

Rates of alanine and glucose turnover and precursor-product interrelationships were determined in patients on chronic hemodialysis and in matched controls using simultaneous primed injection-continuous infusions of [U-¹⁴C] alanine and [2-³H] glucose. In eight chronically dialyzed patients studied before their first dialysis of the week, glucose turnover was 866 ± 120 μmole/min (mean ± SE); after their last dialysis of the week, glucose turnover was 880 ± 63 μmole/min. These rates were 35% (p < 0.05) and 37% (p < 0.01) greater than rates observed in ten normal volunteers (642 ± 28.3 μmole/min). Fasting glucose and insulin levels in dialyzing patients were unchanged from normal. Alanine turnover was increased predialysis (318 ± 55.2 μmoles/min; p < 0.01) and postdialysis (248 ± 32.4 μmole/min; p < 0.01) as compared to normal (168 ± 14.3 μmole/min). In patients pre- and postdialysis, gluconeogenesis from alanine was increased to 34.6 ± 10.9 μmole/min (p < 0.05) and 39.0 ± 6.33 μmole/min (p < 0.05) compared to 20.9 ± 1.63 μmole/min in normal subjects. We conclude that neither acute nor chronic hemodialysis corrects the increased glucose and alanine production and utilization and gluconeogenesis observed in chronic renal failure.