Change of Plasma Ketone Bodies and Skin Gas Acetone in Hemodialysis Patients

Introduction: Ketone body metabolism increases under various pathological conditions, including insulin resistance, inflammation, and heart failure, which are common in hemodialysis patients. This study investigated whether plasma ketone bodies and skin-gas acetone are useful biomarkers of metabolic conditions during hemodialysis. Methods: Twenty patients with end-stage renal disease undergoing maintenance dialysis for at least 9 months were enrolled. To measure plasma ketone body concentrations before and immediately after hemodialysis, blood samples were collected from the shunt vessel. Also, we measured acetone concentration in the vapors emanating from the skin. Results: Plasma ketone body concentrations increased 6-fold after hemodialysis, with a remarkable increase of β-hydroxybutyrate (BOHB) and plasma BOHB/acetoacetate ratio. Conversely, no significant change of skin-gas acetone concentration was observed. Therefore, no association was found between the concentration of plasma ketone bodies and skin-gas acetone. Increased ratio of glucose level and ketone bodies exhibited a positive correlation; however, other laboratory data did not. Increased ratio of plasma BOHB significantly correlated with water removal ratio. Conclusions: We found a significant increase in BOHB-dominant plasma ketone bodies, which significantly correlated with the water removal ratio, and dissociation between the changes in skin-gas acetone and plasma ketone body concentrations after hemodialysis. These results suggest an association between two independently reported cardiovascular risk factors, plasma BOHB concentration and fluid removal amount in hemodialysis patients. Although no association between skin-gas acetone and plasma ketone bodies was observed, the dissociation suggests an increase in ketone body synthesis during hemodialysis.