Research Increase in circulating non-esterified fatty acids during the hemodialysis session: The role of cell starvation

Background Although an increase in plasma levels of non-esterified fatty acids (NEFA) during hemodialysis (HD) is reported, the precise pathophysiology remains unclear. We hypothesized that an elevation in NEFA levels reflects “cell starvation” or sudden-onset catabolism caused primarily by a steep depletion of plasma insulin during the HD session. Materials and Methods We measured in five cases the circulating levels of NEFA and insulin during the HD session under conditions without and with intradialytic parenteral nutrition (IDPN) that can suppress cell starvation. Results Without IDPN, insulin decreased rapidly, and NEFA increased to abnormally high levels. Such a steep elevation in NEFA levels was clearly suppressed in the IDPN condition with maintained levels of insulin. Conclusions Our findings suggest that the main cause of the increase in NEFA during HD is cell starvation.