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Published on: July 19, 2018
Association of Plasma Uremic Solute Levels with Residual Kidney Function in Children on Peritoneal Dialysis
Lakshmi L Ganesan1,2, Frank J O'Brien3, Tammy L Sirich4,5
1Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California.
Insights
Residual kidney function in pediatric peritoneal dialysis patients lowers uremic solute levels. This preservation of kidney function aids in managing solute concentrations, improving patient health outcomes.
Area of Science:
- Nephrology
- Pediatric Dialysis
- Metabolomics
Background:
- Residual native kidney function offers significant health benefits for patients undergoing dialysis.
- It aids in managing fluid balance, electrolyte levels, and reducing the buildup of toxins.
- This study focuses on the role of residual kidney function in pediatric patients on peritoneal dialysis.
Purpose of the Study:
- To investigate the association between residual kidney function and plasma concentrations of uremic solutes in pediatric patients on peritoneal dialysis.
- To determine if preserving kidney function impacts the levels of various toxins in the blood.
Main Methods:
- Analyzed plasma samples from 29 pediatric patients on peritoneal dialysis (13 without, 10 with residual kidney function).
- Utilized untargeted mass spectrometry-based metabolomics to compare plasma solute profiles.
- Measured dialytic and residual clearances of specific solutes using chemical standard assays.
Main Results:
- Patients with residual kidney function had significantly lower plasma levels of 59 out of 256 measured uremic solutes compared to those without.
- Average uremic solute levels were 64% lower in patients with residual kidney function, even with similar dialysis efficacy (Kt/V urea).
- Residual kidney function contributed a greater proportion to the clearance of non-urea solutes than urea itself.
Conclusions:
- Pediatric peritoneal dialysis patients with residual kidney function exhibit lower concentrations of numerous uremic solutes.
- Preserving residual kidney function is crucial for effective toxin management in this population.
- These findings highlight the importance of maintaining native kidney function during dialysis treatment.
Background And Objectives:
Residual native kidney function confers health benefits in patients on dialysis. It can facilitate control of extracellular volume and inorganic ion concentrations. Residual kidney function can also limit the accumulation of uremic solutes. This study assessed whether lower plasma concentrations of uremic solutes were associated with residual kidney function in pediatric patients on peritoneal dialysis.
Design, Setting, Participants, & Measurements:
Samples were analyzed from 29 pediatric patients on peritoneal dialysis, including 13 without residual kidney function and ten with residual kidney function. Metabolomic analysis by untargeted mass spectrometry compared plasma solute levels in patients with and without residual kidney function. Dialytic and residual clearances of selected solutes were also measured by assays using chemical standards.
Results:
Metabolomic analysis showed that plasma levels of 256 uremic solutes in patients with residual kidney function averaged 64% (interquartile range, 51%-81%) of the values in patients without residual kidney function who had similar total Kt/Vurea. The plasma levels were significantly lower for 59 of the 256 solutes in the patients with residual kidney function and significantly higher for none. Assays using chemical standards showed that residual kidney function provides a higher portion of the total clearance for nonurea solutes than it does for urea.
Conclusions:
Concentrations of many uremic solutes are lower in patients on peritoneal dialysis with residual kidney function than in those without residual kidney function receiving similar treatment as assessed by Kt/Vurea.
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