Journal of nephrology
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Hydroelectrolytic equilibrium alteration in dialysis patients before dialytic treatment consists in extracellular volume expansion and hyperkalemia. Extracellular volume expansion is due to salt and water retention. Because of the self-regulation phenomenon of cell volume, it is made prevalently at the expense of extracellular volume. ⋯ In the uremic patient the retention of nitrogenous catabolites causes the slowing- down in ATP production in Krebs' cycle because of prevalent use of this low -efficiency energetic substrate; ATP supply to Na+/K+ pump, which is ATP-asi- dependent, is reduced and consequently so is pump activity. Thanks to nitrogenous catabolite removal, dialysis recovers the use of other major efficiency energetic substrates, such as carbohydrates and lipids, in Krebs' cycle with an increase of ATP production rate and pump activity. This hypothesis could explain the REMP reduction in end-stage uremia and its correction with dialysis.