Nephrol Dial Transplant (2000) 15: 1183-1188
© 2000 European Renal Association-European Dialysis and Transplant Association
Kinetics of carbamylated haemoglobin in acute renal failure
1 Service de Néphrologie, 2 Laboratoire de Pharmacologie and 3 Laboratoire de Biochimie, Centre Hospitalier et Universitaire de Reims, Reims, France
Background. Carbamylation of proteins by isocyanic acid, the reactive form of cyanate derived from urea, is increased in uraemia and may contribute to uraemic toxicity. Kinetics of carbamylation that may reflect uraemic toxicity is not clearly defined in acute renal failure (ARF).
Methods. Twenty-eight patients with ARF and 13 with chronic renal failure (CRF) were included in the study in order to determine changes in carbamylated haemoglobin concentration (CarHb) in ARF. The usefulness of this parameter for differentiating ARF from CRF was also investigated. CarHb was measured by high-performance liquid chromatography after acid hydrolysis.
Results. Mean CarHb level (expressed as µg carbamyl valine per gram (CV/g) Hb) was significantly higher in ARF (54.3±5.2) than in normal subjects (31.6±1.3). On admission, CarHb level was correlated with duration of ARF prior to hospitalization in the intensive care unit (r2=0.723, P<0.001). CarHb was significantly higher at recovery in the subgroup of patients requiring haemodialysis than in the subgroup not requiring haemodialysis (82.4±11.3 vs 46.7±5.2, P<0.01). Similarly dialysis patients lost more weight (8.6±1.4 vs 2.7±0.5 kg, P<0.005) and had higher averaged blood urea levels in the 20 days prior to recovery (17.6±1.9 vs 11.3±1.8 mol/l, P<0.05). After recovery, CarHb level decreased at a rate of 0.219 µg CV/g Hb per day in patients with reversible renal insufficiency. CarHb concentration was higher in patients with CRF. A cut-off CarHb value of 100 µg CV/g Hb had a sensitivity of 94% and a positive predictive value of 94% for differentiating ARF from CRF.
Conclusions. Kinetics of CarHb showed a near normal red blood cell life span in ARF. Changes in CarHb enabled, with a good sensitivity, the distinction to be made between patients who recovered from ARF and those with sustained renal impairment, whether due to prior CRF or resulting from parenchymal sequelae. Measurement of CarHb is valuable at clinical presentation of ARF in patients with an unknown medical history of renal disease.
Keywords: acute renal failure; carbamylation; chronic renal failure; haemodialysis; uraemia
Correspondence and offprint requests to: Professor Jacques Chanard, Centre Hospitalier et Universitaire de Reims, Hôpital de la Maison Blanche, Service de Néphrologie, 45 rue Cognac Jay, F-51092 Reims cedex, France.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. M. Cohen, Y. R. Holmes, T. C. Chenier, and C. H. Joiner Discordance Between HbA1c and Fructosamine: Evidence for a glycosylation gap and its relation to diabetic nephropathy Diabetes Care, January 1, 2003; 26(1): 163 - 167. [Abstract] [Full Text] [PDF]
|
|