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Dialysis modality comparison of insulin-like growth factor binding protein-3 removal in children: could this have a
R P Valentini1, N A Mudge, T E Bunchman
1C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor.
Insights
Children on peritoneal dialysis (PD) show better growth than those on hemodialysis (HD). PD may improve insulin-like growth factor-1 (IGF-1) bioactivity by removing IGF-1 binding protein-3 (IGFBP-3), potentially enhancing growth in pediatric end-stage renal disease (ESRD).
Area of Science:
- Pediatric Nephrology
- End-Stage Renal Disease (ESRD) Research
- Growth Factor Biology
Background:
- Children with end-stage renal disease (ESRD) often exhibit growth delays.
- Peritoneal dialysis (PD) is associated with superior growth in pediatric ESRD patients compared to hemodialysis (HD).
- Elevated insulin-like growth factor binding protein-3 (IGFBP-3) in ESRD may inhibit insulin-like growth factor-1 (IGF-1) bioactivity, potentially impairing growth.
Purpose of the Study:
- To investigate the levels of IGFBP-3 in dialysis effluent from children undergoing PD and HD.
- To explore the potential role of IGFBP-3 clearance in PD as a factor contributing to improved growth in pediatric ESRD.
Main Methods:
- Analysis of IGFBP-3 levels in dialysis effluent samples from children on PD (n=9) and HD (n=3).
- Measurement of IGFBP-3 concentrations in effluent from children on high-efficiency HD dialyzers.
- Comparison of IGFBP-3 levels between PD and HD groups.
Main Results:
- Mean IGFBP-3 level in PD effluent was 0.21 +/- 0.03 mg/L.
- Mean IGFBP-3 level in HD effluent was 0.02 +/- 0.01 mg/L.
- Higher IGFBP-3 levels (0.45 +/- 0.25 mg/L) were observed in effluent from children on high-efficiency HD.
Conclusions:
- Preliminary findings suggest PD may remove IGFBP-3, potentially improving IGF-1 bioactivity and contributing to enhanced growth in pediatric ESRD.
- High-efficiency HD may also offer some clearance of IGFBP-3.
- Further research in larger ESRD populations is warranted to confirm these observations.
Abstract:
Centers have reported superior growth in children on peritoneal dialysis (PD) as compared to hemodialysis (HD). Many factors may influence this outcome including diet, adequacy of dialysis, and control of metabolic acidosis. The role of insulin-like growth factor-1 (IGF-1) and its bioactivity in patients with end-stage renal disease (ESRD) have been recently examined. Insulin-like growth factor binding protein-3 (IGFBP-3) has been shown to be elevated in ESRD, possibly resulting in inhibition of the bioactivity of IGF-1. Potentially, the removal of IGFBP-3 may improve the bioactivity of IGF-1, with resulting improvement in growth. The molecular weight of IGFBP-3 (30.5 kDa) is in the range of other proteins cleared by PD (e.g., albumin-69 kDa). Therefore, we have analyzed 10 samples of IGFBP-3 in the dialysis effluent of 9 children on peritoneal dialysis, and have found that the mean level +/- SEM was 0.21 +/- 0.03 mg/L, while the 3 analyses of children on standard HD was 0.02 +/- 0.01 mg/L. In addition, the effluent of 2 children on a high-efficiency dialyzer had an IGFBP-3 level of 0.45 +/- 0.25 mg/L. Even though quite preliminary, these data may suggest another reason for improved growth in children on PD and a potential advantage to high-efficiency HD. Further analysis in a larger population of ESRD patients will be needed in order to confirm these preliminary findings.