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Plasma pseudouridine levels reflect body size in children on hemodialysis

Frank J O'Brien1, Tammy L Sirich2, Abigail Taussig2

  • 1Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

Pediatric Nephrology (Berlin, Germany)
|November 16, 2019
PubMed

Insights

Dialysis targeting urea reduction may lead to higher pseudouridine levels in smaller children. Measuring solutes proportional to body surface area may better assess dialysis adequacy in pediatrics.

Area of Science:

  • Pediatric Nephrology
  • Renal Replacement Therapy
  • Uremic Toxin Research

Background:

  • Standard dialysis prescription aims for a target spKt/Vurea, which may not adequately account for body surface area (BSA) differences in children.
  • Waste solute production can correlate more closely with BSA than urea distribution volume (Vurea), potentially leading to higher solute levels in smaller children.

Purpose of the Study:

  • To investigate whether dialysis prescribed to a target spKt/Vurea results in elevated plasma levels of pseudouridine (PU) in smaller pediatric patients.
  • To evaluate PU as a novel marker solute for dialysis adequacy, given its production is proportional to BSA.

Main Methods:

  • Measured plasma and dialysate levels of PU and urea nitrogen (ureaN) in 20 pediatric patients undergoing hemodialysis.
  • Utilized mathematical modeling to estimate solute production rates and average plasma solute levels.
  • Analyzed the relationship between patient size (BSA) and plasma solute levels.

Main Results:

  • Dialytic clearance of PU was proportional to that of ureaN.
  • PU production correlated significantly with BSA.
  • Pretreatment plasma PU levels were higher in smaller children, while ureaN levels did not vary with size.

Conclusions:

  • Current dialysis prescriptions based on urea kinetics may result in suboptimal uremic solute clearance in small children.
  • Measuring solutes like PU, which are produced proportionally to BSA, could offer a more accurate assessment of dialysis adequacy in pediatric populations.
Abstract

Keywords:
AdequacyChildrenHemodialysisUremic solutes

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