ESPN 51th Annual Meeting

ESPN 2018


 
Concentrations of protein-bound uremic toxins in children on conventional HD are mainly affected by residual urine production
SNAUWAERT EVELIEN 1 VAN BIESEN WIM 1 RAES ANN 1 GLORIEUX GRIET 1 VANDE WALLE JOHAN 1 ROELS SANNE 1 AZUKAITIS KAROLIS 3 BAYAZIT AYSUN 4 CANPOLAT NUR 5 FISCHBACH MICHEL 6 GODEFROID NATHALIE 7 PAGLIALONGA FABIO 8 SCHAEFER FRANZ 9 SPASOJEVIC BRANKICA 10 STEFANIDIS CONSTATINUS J 11 VAN DYCK MARIA 2 SHROFF RUKSHANA 12 ELOOT SUNNY 1

1- GHENT UNIVERSITY, BELGIUM
2- LEUVEN UNIVERSITY HOSPITAL, BELGIUM
3- VILNIUS UNIVERSITY, LITHUANIA
4- CUKUROVA UNIVERSITY, TURKEY
5- CERRAHPASA SCHOOL OF MEDICINE, TURKEY
6- CHILDRENS DIALYSIS CENTER STRASBOURG, FRANCE
7- UNIVERSITé CATHOLIQUE LOUVAIN, BELGIUM
8- FONDAZIONE IRCCS CA’ GRANDA OSPEDALE MAGGIORE POLICLINICO, ITALY
9- CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE HEIDELBERG, GERMANY
10- UNIVERSITY CHILDRENS HOSPITAL BELGRADE, SERBIA
11- A & P KYRIAKOU CHILDREN’S HOSPITAL ATHENS, GREECE
12- GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST, LONDON, UK
 
Introduction:

The aim of the study was to describe concentrations of representative protein-bound uremic toxins (PBUTs) in children on conventional hemodialysis (HD) versus chronic kidney disease (CKD), and to analyze the impacting factors.

Material and methods:

Total plasma concentrations of PBUTs (p-cresylglucuronide, hippuric acid, indole acetic acid, indoxyl sulfate, p-cresylsulfate, and 3-carboxy-4-methyl-5-propyl-furanpropionic acid) and their %protein binding (%PB) were determined in 65 non-dialysis CKD children (10.8[5.1;14.7]years; 74%boys) and 170 children on HD (14.3[10.3;16.3]years; 54%boys). 88% of children on HD had 10-12h dialysis/week and extended dialysis schedules were excluded. 31.2% were treated with hemodiafiltration. Multivariate analysis of variance (MANOVA type II) was used to compare overall concentrations and %PB of PBUTs between CKD and HD. Subsequently, MANOVA type II was performed to assess the effect of vintage on dialysis, residual urine production (RUP; mL/24h), dialyzer ultrafiltration coefficient (KUF) and surface area/body surface area (SUBSA) on concentrations of the group PBUTs.

Results:

Compared to healthy children, total PBUT concentrations were 0.5-5.2SD and even 8.8-78.7SD higher in respectively children with CKD and on HD (p<.01). Moreover, %PB of PBUTs in children on HD were overall lower compared to CKD. Taking vintage on dialysis into account, RUP of >500mL/24h resulted in lower concentrations of the jointly evaluated PBUTs (p=0.02). Moreover, a vintage on HD less than 2 months (p=0.03) and a higher KUF (p<.01) were associated with lower overall concentrations of PBUTs. No evidence for SUBSA on PBUT concentrations were found. %PB was not impacted by these factors.

Conclusions:

In comparison to children with non-dialysis CKD, children on conventional HD presented with significantly higher PBUT concentrations and lower %PB. We demonstrated that RUP of >500mL/24h, short vintage on HD, and higher KUF were associated with lower PBUTs concentrations. This results highlights the importance of preserving RUP and performing high-flux dialysis in decreasing the concentrations of PBUTs.