Choline loss during hemodialysis: homeostatic control of plasma choline concentrations

Endogenous concentrations of free choline in plasma were measured in azotemic subjects receiving repetitive hemodialysis and excretion of free choline into the dialysate was determined. Chemical choline in plasma and dialysate was measured by adding choline kinase and measuring the production of radiolabelled phosphorycholine in the presence of radiolabelled adenosine triphosphate (ATP). Mean free choline concentration in plasma of azotemic subjects receiving hemodialysis was found to be 37 muM, which is about twice that of normal persons. The total excretion of choline into the dialysate during 360 min averaged 730 mumoles +/- 69 (SEM). Levels of free choline in plasma fell during hemodialysis at two hours but recovered toward predialysis values at six hours. The return of plasma choline concentrations toward control values during dialysis suggests that a feedback mechanism exists which was activated rapidly to produce homeostasis of plasma choline concentrations. In these patients, the degree of peripheral neuropathy as judged by measurement of nerve conduction velocities showed a significant inverse correlation with levels of free choline in plasma.