FREE AND PROTEIN-BOUND TRYPTOPHAN IN SERUM OF UNTREATED PATIENTS WITH CHRONIC-RENAL-FAILURE

In fasting sera from 46 untreated patients with chronic renal failure and in 22 normal subjects, non-protein-bound tryptophan, F, was separated by pH-controlled equilibrium dialysis. Total tryptophan, T, and F were measured by HPLC. Results in patients were related to gender, severity of chronic renal failure (as measured by radioisotopic glomerular filtration rate), protein intake (as measured by 24-hr urinary urea N excretion), and protein nutrition (as measured by serum concentrations of albumin and transferrin). T was subnormal in 59% of the patients. In seven hypoalbuminemic patients, F/T was markedly increased (approaching unity) but F was normal. In 39 non-hypoalbuminemic patients, F was again normal but F/F was often increased at glomerular filtration rates below 30 ml/min/3 m2 of height2, especially in females. T was significantly correlated with estimated protein intake (r = 0.54, P = 0.0004), even though neither F nor serum protein levels were correlated with it. We conclude that the serum level of free tryptophan is well-maintained in chronic renal failure, being uninfluenced by severity of renal insufficiency, voluntary protein intake, or serum protein concentrations. On the other hand, protein-bound tryptophan varies with protein intake, decreases markedly in hypoalbuminemic patients, and also decreases in many nonhypoalbuminemic patients (especially females) when the glomerular filtration rate falls below approximately 30 ml/min/3 m2 of height2.