Residual kidney function lowers plasma levels of uremic solutes in pediatric patients
Plasma uremic solute levels were “significantly lower” in pediatric patients with residual kidney function compared with patients without it, according to data published in Clinical Journal of the American Society of Nephrology.
Previous studies have shown the health benefits of residual kidney function, but few have explored the way it can affect plasma solute levels.
Lakshmi L. Ganesan, MD, assistant professor of medicine at Loma Linda University, and colleagues investigated the potential correlation between plasma concentrations of uremic solutes and residual kidney function in 23 pediatric patients on peritoneal dialysis. There were 13 patients with no residual kidney function (age, 6±5years) and 10 with residual kidney function (age, 12± 4 years). Patients with residual kidney function experienced shorter dialysis treatment times than patients without residual kidney function.
Researchers collected samples of spent dialysate, plasma and urine from patients at routine clinic visits. Using Nanosep 30k Omega separators, researchers prepared plasma ultrafiltrate, and a metabolic analysis evaluated concentrations of uremic solutes in the plasma and plasma ultrafiltrate. Additionally, the dialytic and residual clearances of certain solutes were also measured by assays using chemical standards.
Researchers identified 256 named uremic solutes that could be found in all the patients residual kidney function. Plasma levels of some uremic solutes in patients regardless of residual kidney function averaged 64% of the levels in patients without residual kidney function. Furthermore, the plasma levels were “significantly lower” for 59 of 256 solutes from patients with residual kidney function. Assays using chemical standards revealed that residual kidney function supplies a higher portion of the total clearance for nonurea solutes than it does for urea.
“Our results provide further evidence that total urea clearance is an imperfect measure of dialysis adequacy. This is consistent with the recent recommendation of the International Society of Peritoneal Dialysis that the dialysis prescription does not need to be adjusted to achieve a target Kt/V urea,” Ganesan and colleagues concluded. “Better knowledge of which solutes are toxic could provide a superior index of treatment adequacy.”
The limitations of this study include a small and unmatched group of patients.
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