Effect of acetate on ketogenesis during hemodialysis

The concentration of plasma acetate, glucose, and ketone bodies were determined for both venous and arterial blood before and at the end of dialysis with an acetate-containing dialysate. We also determined lactate and pyruvate levels in arterial plasma. The results obtained in the same patients were compared when dialysis were done with or without glucose and discussed in terms of hormonal changes (insulin, glucagon). Arterial plasma acetate (p less than 0.001) and ketone body levels (p less than 0.05) increased significantly during dialysis both with glucose and without glucose (p less than 0.001 in both cases). Higher end-dialysis arterial levels were found for the latter set of glucose-free dialysis (p less than 0.05 and p less than 0.001, respectively, for acetate and ketone bodies), and a correlation was established between end-dialysis arterial concentrations of acetate and ketone bodies. This suggests high consumption of both endogenous and exogenous acetate to feed ketogenesis. This is concurrent with decreased insulin and high glucagon levels. Under these conditions, plasma accumulation of ketone bodies would facilitate an indirect elimination of acetate by the dialyzer (about 10% of the acetate load). Our results suggest that hormone variations during glucose-free dialysis which promote fatty acid oxidation and ketogenesis from acetyl groups hinder acetate-dependent lipogenesis.