The relationship of carbamylated proteins with dialysis adequacy in dialysis dependent patients due to chronic renal failure

Objective: Rapidly increasing in our country and in the world, chronic kidney disease is a public health problem of which the progress can be stopped or prevented. Usually developing based on this disease, end-stage renal disease constitutes an important cause of mortality and morbidity. The risk of mortality and morbidity can be reduced by adequate and effective dialysis for patients who are dialysis-dependent due to end-stage renal disease. Our study aims to show the traditional parameters Kt/V and urea reduction ratio (URR) and the role and place of carbamylated proteins in demonstrating dialysis adequacy. Material and Methods: Thirty-six adult patients who regularly underwent dialysis for different etiological reasons in the Hemodialysis Unit of the Nephrology Polyclinic of our hospital were included in our study after obtaining the informed consent form and approval of the ethics committee. Routine biochemical parameters, hemogram, carbamylated low-density lipoprotein (cLDL), and carbamylated albumin (cAlb) values in blood samples taken from patients after dialysis were evaluated by including demographic characteristics, Kt/V, and URR results. Results: Of the 36 patients included in the study, 44.4% (16) were female and 55.6% (20) were male. The mean age was calculated as 51.9±21.9 years. When the parameters were examined, it was detected that the ultimate values of blood urea nitrogen (BUN), creatinine (Cr), calcium (Ca), magnesium (Mg), phosphorus (Pi), albumin and cAlb values were higher compared to the values of those at the beginning (respectively p= 0.043; p=0.013; p=0.002; p=0.020; p=0.026; p=0.016; p<0.001). On the other hand, C-Reactive protein (CRP), cLDL, Kt/V, and URR values at 6th months were found to be lower than those at at the beginning (p=0.006; p<0.001; p<0.001; p<0.001, respectively). In the initial phase of the study, there was a strong positive correlation between Kt/V value, and URR value (r=0.764; p<0.001). Also a moderate positive correlation was found between URR value, and cAlb value at the beginning (r=0.343; p=0.040). A very strong positive correlation was found between the 6th month Kt/V value, and the 6th month's URR value (r=0.960; p<0.001). It was observed that initial Kt/V value and URR value were lower in male patients than in female patients (p=0.004; p=0.020, respectively). Compared to the patients not using erythrocyte stimulating agent (ESA), the patients using it had lower URR initially (p=0.039; p<0.05). Conclusion: Our study demonstrated a significant relationship between cLDL, cAlb, and the conventional indicators of dialysis adequacy, Kt/V, and URR. Further comprehensive studies involving more patients are needed to show that the carbamylated proteins play a significant role in dialysis adequacy, as well as their role in predicting mortality and morbidity of dialysis patients. Keywords: Chronic Kidney Disease, End Stage Renal Failure, Protein Carbamylation, Carbamylated LDL, Carbamylated Albumin