Kidney failure affects 25 million individuals in the U.S. and many, many more throughout the world. Loss of kidney function means the majority of these patients must undergo dialysis treatments to remove excess fluids and waste products. Although dialysis therapy coupled with medication has improved the life expectancy for people with kidney failure, for unknown reasons, patients' risk of sudden heart failure and death remains 10 to 20 times greater than average.
A new study helps explain why this may be the case. Appearing on-line in Science Translational Medicine, the new findings show that a process known as protein carbamylation contributes to heart disease risk among patients with kidney failure undergoing dialysis, and demonstrates that a blood test to measure carbamylated albumin protein can help clinicians better gauge the effectiveness of dialysis and identify patients at risk of cardiac complications. The findings additionally suggest the need for further investigation to determine if therapy with supplemental amino acids could help to prevent the carbamylation process.
The problem arises due to accumulation of urea in patients blood. Although urea is generally non-toxic, in some cases it can degrade into cyanate, a toxic chemical that binds to and permanently modifies proteins through a process known as carbamylation.
In two independent clinical experiments, the investigators demonstrated that increased carbamylated albumin is strongly associated with an elevated risk of premature death in patients on dialysis. They additionally found that increased carbamylated albumin in dialysis patients was linked with low blood concentrations of amino acids, the building blocks of proteins.
Reported in a Eureka press release