2,3-Diphosphoglyceric Acid Changes in Uremia and During Hemodialysis

The present study is an investigation of the mechanism of changes in erythrocyte 2,3-diphosphoglyceric acid (2,3-DPG) in patients with chronic renal failure during hemodialysis. The study was conducted on 7 Korean and 6 American patients on maintenance hemodialysis. The plasma pH of Korean patients was 7.31±0.02 before hemodialysis and 7.40±0.04 after hemodialysis (p<0.001). The pH of erythrocyte also increased from 7.13±0.02 to 7.20±0.03. The concentration of hemoglobin 2,3-DPG in Korean patients was 10.86±2.89 μmol/g before hemodialysis and 19.93±2.89 μmol/g after hemodialysis (p<0.001). Similar results were obtained in American patients. Hemoglobin 2,3-DPG was 12.54±2.53 and 18.76±6.73 μmol/g before and after dialysis respectively. Despite the presence of substantial anemia, hemoglobin 2,3-DPG prior to hemodialysis was significantly lower than the values obtained in the normal controls (17.45±4.3 μmol/g). The blood glucose increased from 93.3±8.5 mg/dl before dialysis to 117.1±6.1 mg/dl after hemodialysis in Korean patients but no significant change was detected in American patients. The increased blood glucose with hemodialysis observed in Korean patients was probably attributable to the lower baseline glucose concentration and the gain of glucose from dialysate, which had a glucose concentration of 186±34.1 mg/dl. The results suggest that the increase in 2,3-DPG with hemodialysis is probably caused by an increase of pH and an increased glucose utilization.