Elevated ATP levels in the red cells of patients with renal failure

Summary

Red cell ATP levels were measured in 65 patients with renal failure and in 50 controls using the firefly luciferin luciferase assay. The average ATP levels were increased in patients with renal failure (4.88 µmol/g Hb,p < 0.01) as compared to the controls (3.64 µmol/g Hb). A correlation was obtained between red cell ATP levels and inorganic serum phosphate (r=0.6186,p<0.001). ATP levels and correlation to inorganic serum phosphate were further analysed in respect to treatment of renal insufficiency by hemodialysis, peritoneal dialysis (CAPD), kidney transplantation or duration of renal disease. No significant differences were observed except that red cell ATP did not correlate with inorganic serum phosphate in patients treated by CAPD. The severity of renal disease as judged by clinical findings was not related to red cell ATP levels. The mechanisms leading to elevated red cell ATP levels in uremic subjects are not completely understood. A stimulated red cell glycolysis due to hyperphosphatemia, a reduced ATP hydrolysis due to inhibition of membrane bound Na/K ATPase and a younger red cell population in patients with renal insufficiency were put forward. There is some evidence that an altered adenosine metabolism is also involved.