Journal Article

Kinetics of carbamylated haemoglobin in acute renal failure

Alain Wynckel, Christine Randoux, Hervé Millart, Catherine Desroches, Philippe Gillery, Eric Canivet and Jacques Chanard

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 15, issue 8, pages 1183-1188
Published in print August 2000 | ISSN: 0931-0509
Published online August 2000 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/15.8.1183
Kinetics of carbamylated haemoglobin in acute renal failure

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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

Journal Article.  3409 words.  Illustrated.

Subjects: Nephrology

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