Accumulation of trimethylamine and trimethylamine-N-oxide in end-stage renal disease patients undergoing haemodialysis

• Published in: Nephrology, dialysis, transplantation Vol. 21; no. 5; pp. 1300 - 1304
• Main Authors: Bain, Marcus A., Faull, Randall, Fornasini, Gianfranco, Milne, Robert W., Evans, Allan M.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2006; Oxford Publishing Limited (England)
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Case-Control Studies; Disease Progression; Emergency and intensive care: renal failure. Dialysis management; end-stage renal disease; Female; Follow-Up Studies; gas chromatography; Humans; Intensive care medicine; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - therapy; Kidney Function Tests; Male; Medical sciences; Methylamines - blood; Methylamines - metabolism; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Probability; Reference Values; Renal Dialysis - adverse effects; Renal Dialysis - methods; Renal failure; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; trimethylamine; trimethylamine-N-oxide; Kidney disease; Human; trimethylamine-N-oxide; Gas chromatography; Extrarenal dialysis; Urinary system disease; Hemodialysis; Renal failure; trimethylamine; Terminal stage; end-stage renal disease
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfk056

Background. Trimethylamine (TMA) is a short-chain tertiary aliphatic amine that is derived from the diet either directly from the consumption of foods high in TMA or by the intake of food high in precursors to TMA, such as trimethylamine-N-oxide (TMNO), choline and l-carnitine. The clinical significance of TMA may be related to its potential to contribute to neurological toxicity and ‘uraemic breath’ in patients with end-stage renal disease (ESRD). Methods. Concentrations of TMA and TMNO in plasma from 10 healthy adults (not on haemodialysis) and 10 adults with ESRD undergoing haemodialysis (pre- and post-dialysis) were determined by gas chromatography–mass spectrometry. Results. The concentrations of TMA and TMNO in pre-dialysis plasma (1.39±0.483 and 99.9±31.9 μM, respectively) were significantly (P<0.05) higher than the corresponding levels in healthy subjects (0.418±0.124 and 37.8±20.4 μM, respectively). However, there were no significant differences between post-dialysis and healthy subject plasma concentrations. In the ESRD patients, there was a significant (P<0.05) reduction in plasma TMA (from 1.39±0.483 to 0.484±0.164 μM) and TMNO (from 99.9±31.9 to 41.3±18.8 μM) during a single haemodialysis session. Conclusions. TMA and TMNO accumulate between haemodialysis sessions in ESRD patients, but are efficiently removed during a single haemodialysis session.