Nephron 22: 312-315 (1978)
Changes in Copper and Ceruloplasmin in Chronic Renal Insufficiency Treated by Hemodialysis and Peritoneal Dialysis J. Bustamante, M. C. Martin Mateo, A. De Paula de Pedro and O. Ortiz Manchado Department of Internal Medicine, School of Medicine, Valladolid
Key Words. Copper • Ceruloplasmin • Peritoneal dialysis • Hemodialysis Abstract. Serum copper and ceruloplasmin as well as other parameters in 68 patients with chronic renal insufficiency were studied. It was found that chronic renal insufficiency increases neither the serum copper nor the serum ceruloplasmin. In the group on hemodialysis, there is a progressive increase of copper and ceruloplasmin in serum due to a liberation of 44.44% of the copper content of the membranes. In the group on periodic peritoneal dialysis, there is also an increase of serum copper during the dialysis. We do not have an explanation for this finding.
The modern use of renal dialysis in the treatment of chronic renal insufficiency has become widespread. However, many side effects have been recognized following its pro longed use, such as infections, hemorrhages, imbalance of electrolytes as well as abnormal concentrations of metals whose mechanisms are not well understood. We intended (1) to study the behavior of copper and ceruloplasmin in uremics and, especially, in those treated by hemodialysis; (2) to try to find the sources of contamination and the role that dialysis membranes might have in it; (3) to estimate the possible copper and ceruloplasmin participation in the develop ment of complications in such patients; (4) to study points (1) and (3) in patients on peri toneal dialysis.
Materials and Methods We studied 68 patients, 53 males and 15 females, divided into 3 groups. First group: 33 patients, 26 males and 7 females, with chronic renal insufficiency. Second group: 23 patients, 16 males and 7 females (aged 28-63 years), with chronic renal insufficiency on hemodialysis (time 6-69 months). The patients were dialyzed on Travenol, using a UF 100 coil, for 8 h twice a week. All patients had per day a 60-grant pro tein, 2-gram NaCl and 50 ntEq K diet. Third group: 12 patients, 11 males and 1 female (aged 17-53 years), with chronic renal insufficiency on peritonea! dialysis. They were dialyzed for 32 h a week. The dialysate (osmolarity 295 mosm/1) had the fol lowing composition (values in mEq/1): Na, 132; K, 2.6; acetate, 35; Cl, 101; Mg, 1.5; Ca, 3.5. Na, urea, creatinine, uric acid, glucose serum, os molarity, bilirubin, SGOT, SGPT, LDH, Australia antigen, protein electrophoresis and serum iron were measured by standardized laboratory techniques. Cop per was determined by atomic absorption spectro-
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Introduction
Copper and Ceruloplasmin in Hemodialyzed and Peritoneal Dialysis
313
Table I. Values of copper and ceruloplasmin in renal chronic patients (mean ± SD values)
Ceruloplasmin, mg% Copper, ¡zg% Plasma Fe, ¡zg%
Renal chronic patients
Under hemodialysis
Under peritoneal dialysis
22.73 ± 4.32 106.6 ±10.8 102.5 ±18.4
22.47 ± 4.55 116.5 ±19.19 97.2 ±13.8
21.95 ± 4 112.58 ± 15.61 82.50 ± 12.3
Table II. Values of copper and ceruloplasmin in hemodialysis (mean ± SD values)
Ceruloplasmin, mg% Copper, pg% Copper on membrane, p.g/100 cm2 Plasma Fe, jig%
After hemodialysis
P
22.47 ± 4.55 116.56 ± 19.19 21.6 ± 0.1 97.2 ±13.8
22.58 ± 3.33 141.78 ±25.13 9.61 ± 1.86 95.7 ± 1 7
n.s.a
Changes in Copper and Ceruloplasmin in Chronic Renal Insufficiency Treated by Hemodialysis and Peritoneal Dialysis J. Bustamante, M. C. Martin Mateo, A. De Paula de Pedro and O. Ortiz Manchado Department of Internal Medicine, School of Medicine, Valladolid
Key Words. Copper • Ceruloplasmin • Peritoneal dialysis • Hemodialysis Abstract. Serum copper and ceruloplasmin as well as other parameters in 68 patients with chronic renal insufficiency were studied. It was found that chronic renal insufficiency increases neither the serum copper nor the serum ceruloplasmin. In the group on hemodialysis, there is a progressive increase of copper and ceruloplasmin in serum due to a liberation of 44.44% of the copper content of the membranes. In the group on periodic peritoneal dialysis, there is also an increase of serum copper during the dialysis. We do not have an explanation for this finding.
The modern use of renal dialysis in the treatment of chronic renal insufficiency has become widespread. However, many side effects have been recognized following its pro longed use, such as infections, hemorrhages, imbalance of electrolytes as well as abnormal concentrations of metals whose mechanisms are not well understood. We intended (1) to study the behavior of copper and ceruloplasmin in uremics and, especially, in those treated by hemodialysis; (2) to try to find the sources of contamination and the role that dialysis membranes might have in it; (3) to estimate the possible copper and ceruloplasmin participation in the develop ment of complications in such patients; (4) to study points (1) and (3) in patients on peri toneal dialysis.
Materials and Methods We studied 68 patients, 53 males and 15 females, divided into 3 groups. First group: 33 patients, 26 males and 7 females, with chronic renal insufficiency. Second group: 23 patients, 16 males and 7 females (aged 28-63 years), with chronic renal insufficiency on hemodialysis (time 6-69 months). The patients were dialyzed on Travenol, using a UF 100 coil, for 8 h twice a week. All patients had per day a 60-grant pro tein, 2-gram NaCl and 50 ntEq K diet. Third group: 12 patients, 11 males and 1 female (aged 17-53 years), with chronic renal insufficiency on peritonea! dialysis. They were dialyzed for 32 h a week. The dialysate (osmolarity 295 mosm/1) had the fol lowing composition (values in mEq/1): Na, 132; K, 2.6; acetate, 35; Cl, 101; Mg, 1.5; Ca, 3.5. Na, urea, creatinine, uric acid, glucose serum, os molarity, bilirubin, SGOT, SGPT, LDH, Australia antigen, protein electrophoresis and serum iron were measured by standardized laboratory techniques. Cop per was determined by atomic absorption spectro-
Downloaded by: Karolinska Institutet, University Library 130.237.122.245 - 8/29/2018 10:13:22 AM
Introduction
Copper and Ceruloplasmin in Hemodialyzed and Peritoneal Dialysis
313
Table I. Values of copper and ceruloplasmin in renal chronic patients (mean ± SD values)
Ceruloplasmin, mg% Copper, ¡zg% Plasma Fe, ¡zg%
Renal chronic patients
Under hemodialysis
Under peritoneal dialysis
22.73 ± 4.32 106.6 ±10.8 102.5 ±18.4
22.47 ± 4.55 116.5 ±19.19 97.2 ±13.8
21.95 ± 4 112.58 ± 15.61 82.50 ± 12.3
Table II. Values of copper and ceruloplasmin in hemodialysis (mean ± SD values)
Ceruloplasmin, mg% Copper, pg% Copper on membrane, p.g/100 cm2 Plasma Fe, jig%
After hemodialysis
P
22.47 ± 4.55 116.56 ± 19.19 21.6 ± 0.1 97.2 ±13.8
22.58 ± 3.33 141.78 ±25.13 9.61 ± 1.86 95.7 ± 1 7
n.s.a
