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Phosphate in dialysis patients.

H Sugisaki, M Onohara, T Kunitomo

    Transactions - American Society for Artificial Internal Organs
    |January 1, 1983
    PubMed
    Summary

    Red blood cells (RBCs) may contain phosphate (Pi) precursors, as Pi efflux from RBCs differs from BUN and creatinine. Uremic RBCs show altered levels of ATP and sugar phosphates, suggesting complex intracellular Pi metabolism.

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    Area of Science:

    • Biochemistry
    • Physiology
    • Nephrology

    Background:

    • Hemodialysis (HD) involves managing plasma levels of solutes like phosphate (Pi), blood urea nitrogen (BUN), and creatinine (Cr).
    • Red blood cells (RBCs) are potential reservoirs for intracellular solutes, influencing their removal during HD.
    • Understanding solute dynamics within RBCs is crucial for optimizing HD efficacy and patient outcomes.

    Purpose of the Study:

    • To investigate the transport mechanisms of phosphate (Pi) across the red blood cell (RBC) membrane during hemodialysis (HD).
    • To explore the role of RBCs as potential reservoirs for Pi and other solutes.
    • To identify intracellular precursors or metabolites related to Pi within RBCs.

    Main Methods:

    • Modeling of extracellular Pi changes during HD.
    • Incubation of bovine and human RBCs with solute-free NSS or dialyzed plasma.
    • Measurement of Pi, BUN, and Cr concentrations in RBCs and incubation media.
    • 31P Nuclear Magnetic Resonance (NMR) spectroscopy of packed RBCs.

    Main Results:

    • Pi efflux from RBCs did not follow simple diffusion kinetics, unlike BUN and Cr.
    • RBC Pi concentration remained stable during HD despite plasma Pi decrease, suggesting intracellular Pi regulation or precursors.
    • Uremic RBCs exhibited higher ATP and unidentified compounds (potentially sugar phosphates) compared to non-uremic RBCs.
    • 31P NMR showed decreased unidentified compounds in uremic RBCs post-dialysis and decreased 2,3-DPG with increased Pi during incubation.

    Conclusions:

    • Phosphate transport in RBCs during HD is complex and may involve intracellular precursors, not simple diffusion.
    • Uremic RBCs display altered intracellular phosphate metabolism, including changes in ATP and sugar phosphate levels.
    • These findings suggest novel therapeutic targets for managing phosphate balance in kidney disease patients undergoing HD.

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