Hemodialysis and Ketogenic Diets: Cancer, a formidable global health adversary marked by limited treatment avenues and recurrent resistance, might find a complementary ally in HD. This supplementary treatment aims to elevate survival rates in aggressive cancers. The traditional arsenal against cancer—surgery, radiation, and chemotherapy—could potentially gain augmentation through a ketogenic diet. This diet induces a metabolic state akin to prolonged fasting, presenting a potential solution to dietary challenges faced by cancer patients.
Replicating the effects of fasting, glucose-free dialysis curtails insulin and glucose levels. Meanwhile, high-flux hemodialyzers, when combined with a ketogenic diet, could amplify ketosis. However, this combination might also pose the challenge of reducing ketosis by eliminating ketone bodies.
The study enlisted six male Sprague-Dawley rats, each weighing approximately 316 grams, to scrutinize the impact of HD following a five-day ketogenic diet. Commencing with a standard diet, the rats transitioned to a ketogenic diet under strict adherence to ethical standards, approved by the relevant ethical committee.
Critical medical procedures, including vein and artery cannulation for blood sampling, continuous monitoring, and connection to the HD apparatus, were meticulously conducted. The HD process, facilitated by a specialized blood circuit primed with albumin and heparin, employed an advanced HD system equipped with a high-flux membrane dialyzer. Blood samples were intermittently collected during the three-hour dialysis session to monitor physiological changes.
Simulations were also conducted to comprehensively grasp the impact of dialysis on blood composition. Adapted to human conditions, these simulations accounted for the dialysis-clearing effect and assumed no nutrient intake during the process.
rats on a five-day ketogenic diet exhibited a weight gain ranging from 10-37 grams. Pre-dialysis, baseline parameters such as arterial pH, actual bicarbonate, base excess, oxygen pressure (pO2), and carbon dioxide pressure (pCO2) were recorded. The three-hour HD procedure was followed by a 30-minute rest period before concluding the experiment.
In terms of acid-base balance and blood chemistry, plasma base excess increased during dialysis, leading to elevated arterial pH. Post-dialysis, arterial pCO2 levels remained unchanged. While blood hemoglobin levels showed no significant change, plasma potassium levels increased, with no marked difference in plasma sodium levels.
Simulations suggested that substantial lowering of blood glucose levels through dialysis is achievable after the depletion of liver glycogen stores, typically taking about three hours from the initiation of dialysis. Delaying dialysis until this depletion occurs may enhance the impact. Furthermore, dialysis reduced blood glucose and insulin levels while slightly elevating ketone levels.
In-depth analysis of substance transport patterns revealed that the delivery and removal of ketones to and from the blood were predominantly balanced, with dialysis constituting only a minor fraction of these processes.
Dialysis exerted a more pronounced effect on glucose and insulin by significantly reducing consumption rates. A simulation assuming zero insulin clearance during dialysis showed a notable reduction in glucose levels and a slight decrease in ketone levels, albeit higher than without dialysis.
This study opens avenues for understanding how HD could potentially enhance ketosis and, in turn, improve cancer treatments. Further research is warranted to unravel the intricate metabolic effects and achieve a delicate balance in the removal of ketone bodies during HD.