Effects of acetate on glucose metabolism and cellular ATP content during hemodialysis

In view of multiple interactions of acetate with intermediary metabolism, we studied the effects of the exogenous acetate load during dialysis on glucose and energy metabolism. IV glucose tolerance test (glucose 0.33 g/kg BW) and platelet ATP content were evaluated in 16 patients before and after a single hemodialysis session with acetate 38 mEq/l in the dialysate. IV glucose tolerance was greatly impaired in all patients after hemodialysis (K: 1.08 +/- 0.30 vs predialysis value of 2.05 +/- 0.85, p less than 0.001). Platelet ATP content was unchanged by dialysis (3.74 +/- 1.02 mumol/10(11) PLTs before and 3.55 +/- 0.69 mumol/10(11) PLTs after), however, individual variations in platelet ATP content ranged from +32 to -31% of the initial values. Postdialysis plasma acetate levels ranged from 1.5 to 9.2 mmol/l and were inversely correlated with postdialysis glucose tolerance test (r: -0.61, p less than 0.01) and platelet ATP content variations (r: -0.51, p less than 0.05). Our study demonstrates that glucose utilization is acutely impaired by acetate dialysis and suggests that the reduced glycolytic activity may be due to a negative feed-back mechanism in the presence of exogenous fuel. It also demonstrates a great variability in platelet ATP content following hemodialysis, which probably depends on the different patients' ability to oxidize acetate.