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Published on: November 8, 2015
Dried Blood Spot Sampling for Monitoring Children With Immune-Mediated Glomerulopathies and After Kidney
Lena Brunkhorst1, Michael Terhardt2, Björn Bulitta2
1Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
Insights
Dried blood spot (DBS) sampling is a reliable method for monitoring pediatric kidney function and immunosuppressant drug levels. This approach reduces patient burden and facilitates telehealth, improving care for children with kidney transplants or glomerulopathies.
Area of Science:
- Pediatric Nephrology
- Clinical Chemistry
- Pharmacology
Background:
- Monitoring kidney function and immunosuppressant levels in children post-kidney transplantation or with glomerulopathies is challenging.
- Frequent venipunctures and clinic visits create a significant burden for patients and families.
- Capillary dried blood spot (DBS) sampling presents a less invasive alternative.
Purpose of the Study:
- To evaluate the reliability of capillary DBS for therapeutic drug monitoring (TDM) and kidney function assessment in pediatric patients.
- To compare DBS results with standard venous serum samples for key analytes.
- To assess patient and family preferences regarding DBS sampling and telehealth.
Main Methods:
- A prospective single-center study enrolled 89 children (kidney transplant recipients and those with immune-mediated glomerulopathies).
- Simultaneous collection of capillary DBS and venous serum samples for tacrolimus, cyclosporine A, everolimus, and creatinine.
- Patient feedback on pain perception and feasibility was collected via questionnaire.
Main Results:
- No significant differences were observed between DBS and standard methods for creatinine, everolimus, tacrolimus, and cyclosporine A.
- DBS demonstrated sufficient accuracy compared to conventional venous blood tests.
- Patients preferred DBS sampling and telehealth consultations due to reduced travel and school absences, favoring finger pricking.
Conclusions:
- Capillary DBS is a reliable method for TDM and kidney function assessment in pediatric kidney disease.
- DBS significantly reduces the burden on patients and families compared to traditional venipuncture.
- The adoption of DBS sampling supports the integration of telehealth, enhancing patient care and accessibility.
Introduction:
Monitoring kidney function and immunosuppressant levels in children post-kidney transplantation or those with glomerulopathies is challenging due to frequent venipunctures and clinic visits. Capillary dried blood spot sampling (DBS) offers a potential alternative.
Methods:
In this prospective single-center study, 89 children (38% female and 62% male) requiring therapeutic drug monitoring (TDM) and kidney function assessment were enrolled. Of the patients, 79% were kidney transplant recipients, and 21% had immune-mediated glomerulopathies. The mean age was 13.4 (range, 5.7-18.0) years. DBS and standard venous serum samples were collected simultaneously for tacrolimus (TAC), cyclosporine A (CsA), everolimus (EVR), and creatinine levels. Furthermore, patient feedback on pain perception and feasibility was collected via questionnaire.
Results:
No significant differences in parameter values between DBS and standard methods were observed (creatinine, -1.7 ± 14.5 μmol/l; EVR, 0.1 ± 1.2 μg/l; TAC, 0.3 ± 1.1 μg/l; CsA, 2.8 ± 9.8 μg/l). DBS demonstrated sufficient accuracy compared with standard methods. Patients favored DBS and telehealth consultations, especially due to less travel and school absences. Patients preferred finger pricking over ear pricking.
Conclusion:
Capillary DBS proves reliable for TDM and kidney function assessment in pediatric kidney disease. It reduces patient and family burden compared with venous blood collection and enables telehealth consultations.
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