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Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population

Evelien Snauwaert1, Els Holvoet2, Wim Van Biesen3

  • 1Ghent University Hospital, 9000 Ghent, Belgium. evelien.snauwaert@uzgent.be.

Toxins
|April 27, 2019
PubMed

Insights

Pediatric hemodialysis patients have higher protein-bound uremic toxin (PBUT) levels. Residual kidney function and age significantly impact PBUT levels and protein binding in children undergoing hemodialysis.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Clinical Chemistry

Background:

  • Protein-bound uremic toxins (PBUTs) are implicated in the complications of pediatric hemodialysis (HD).
  • Limited data exists on PBUT levels and protein binding (%PB) in children on HD.
  • Understanding these factors is crucial for managing multisystem disease in this population.

Purpose of the Study:

  • To evaluate the levels and %PB of six PBUTs in pediatric HD patients.
  • To compare PBUT profiles with healthy children and those with chronic kidney disease (CKD) stage 4-5.
  • To investigate the influence of age and residual kidney function on PBUTs.

Main Methods:

  • Cross-sectional study of 170 pediatric HD patients, 24 CKD stage 4-5 patients, and healthy controls.
  • Assessed six PBUTs, beta2-microglobulin (β2M), and uric acid (UA).
  • Used analysis of covariance and Spearman correlation to explore age and residual kidney function impacts.

Main Results:

  • HD patients showed higher levels of β2M, p-cresyl glucuronide (pCG), hippuric acid (HA), indole acetic acid (IAA), and indoxyl sulfate (IxS) compared to CKD4-5.
  • Age positively correlated with pCG, HA, indoxyl sulfate (IxS), and p-cresyl sulfate (pCS) levels in HD patients.
  • Residual urine volume negatively correlated with multiple PBUT levels and positively with %PB.

Conclusions:

  • Residual kidney function and age are key determinants of PBUT levels and %PB in pediatric HD.
  • Lower %PB was observed in HD patients compared to CKD4-5.
  • Age-dependent increases in %PB for IAA, IxS, and pCS were noted.

Keywords:
childchronic kidney diseaseend-stage kidney diseasehemodialysisresidual kidney functionuremic toxins

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