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Oxalate elimination via hemodialysis or peritoneal dialysis in children with chronic renal failure
Insights
Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) show similar weekly oxalate elimination in children, despite HD
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Oxalate Metabolism
Background:
- Detailed studies on oxalate elimination and dialysance in pediatric patients undergoing renal replacement therapy are limited.
- Understanding oxalate handling is crucial for managing patients with kidney disease, especially those with primary hyperoxaluria.
Purpose of the Study:
- To compare plasma oxalate levels, oxalate elimination, and oxalate dialysance in pediatric patients undergoing continuous ambulatory peritoneal dialysis (CAPD) versus hemodialysis (HD).
- To assess the efficacy of different dialysis modalities in managing oxalate levels in children, including those with primary hyperoxaluria.
Main Methods:
- Plasma oxalate, oxalate elimination, and dialysance were measured in 15 pediatric patients on CAPD and 10 on HD.
- Patients included those with primary hyperoxaluria.
- Dialysis parameters such as duration, frequency, and dwell volume were recorded.
Main Results:
- Oxalate dialysance was significantly higher with HD compared to CAPD.
- Despite differences in dialysance, mean weekly oxalate elimination was comparable between CAPD and HD.
- Plasma oxalate levels remained elevated in both treatment groups, particularly in patients with primary hyperoxaluria.
- More frequent hemodialysis may enhance oxalate elimination.
Conclusions:
- Both CAPD and HD achieve similar weekly oxalate elimination in pediatric patients.
- Elevated plasma oxalate persists with both dialysis modalities, necessitating further management strategies, especially for primary hyperoxaluria patients.
- Optimizing hemodialysis frequency could improve oxalate removal in pediatric patients.
Abstract:
Oxalate elimination and oxalate dialysance via hemodialysis (HD) or peritoneal dialysis (CAPD) has not been studied in detail in pediatric patients. We studied plasma oxalate, oxalate elimination, and oxalate dialysance in 15 infants and children undergoing CAPD (9 female, 6 male, aged 9 months to 18 years) and in 10 children on HD (4 female, 6 male, aged 7-18 years). Two children in each group had primary hyperoxaluria (PH). The mean duration of dialysis prior to examination was 12 +/- 11 months in CAPD and 31 +/- 23 months in HD patients. Bicarbonate HD was performed 5 h three times a week, CAPD consisted of five daily exchanges in 5 patients and four changes in the remaining 10 children (dwell volume 40 ml/kg body weight, 2.3 g/l glucose). Although oxalate dialysance was significantly higher in HD (mean 115.6 ml/ min per 1.73 m2 in HD versus 7.14 ml/min in CAPD), mean oxalate elimination per week was not different between both renal replacement therapies (3,478 mumol/1.73 m2 surface area/week in CAPD versus 3,915 mumol/1.73 m2 per week in HD). Oxalate elimination in patients with PH was between 6,650 and 9,900 mumol/week. Plasma oxalate remained elevated in both procedures [28-84 mumol/l in CAPD (92/148 in PH) and 33-101 mumol/l in HD (70/93 in PH)]. Oxalate elimination can be increased by a more frequent hemodialysis regimen.