Evelien Snauwaert1, Wim Van Biesen2, Ann Raes3, Griet Glorieux2, Valerie Van Bogaert1, Koen Van Hoeck4, Marc Coppens5, Sanne Roels6, Johan Vande Walle3, Sunny Eloot2. 1. Department of Paediatrics and Medical Genetics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. 2. Department of Nephrology, Ghent University Hospital, Ghent, Belgium. 3. Department of Paediatric Nephrology, Ghent University Hospital, Ghent, Belgium. 4. Department of Paediatric Nephrology, Antwerp University Hospital, Antwerp, Belgium. 5. Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium. 6. Department of Data Analysis, Faculty of Psychology and Pedagogy, Ghent University, Ghent, Belgium.
Abstract
Background: Chronic kidney disease (CKD) in childhood is poorly explained by routine markers (e.g. urea and creatinine) and is better depicted in adults by other uraemic toxins. This study describes concentrations of representative uraemic toxins in non-dialysis CKD versus healthy children. Methods: In 50 healthy children and 57 children with CKD Stages 1-5 [median estimated glomerular filtration rate 48 (25th-75th percentile 24-71) mL/min/1.73 m2; none on dialysis], serum concentrations of small solutes [symmetric and asymmetric dimethyl-arginine (SDMA and ADMA, respectively)], middle molecules [β2-microglobuline (β2M), complement factor D (CfD)] and protein-bound solutes [p-cresylglucuronide (pCG), hippuric acid (HA), indole-acetic acid (IAA), indoxyl sulphate (IxS), p-cresyl sulphate (pCS) and 3-carboxy-4-methyl-5-propyl-furanpropionic acid (CMPF)] were measured. Concentrations in the CKD group were expressed as z-score relative to controls and matched for age and gender. Results: SDMA, CfD, β2M, IxS, pCS, IAA, CMPF and HA concentrations were higher in the overall CKD group compared with controls, ranging from 1.7 standard deviations (SD) for IAA and HA to 11.1 SD for SDMA. SDMA, CfD, β2M, IxS and CMPF in CKD Stages 1-2 with concentrations 4.8, 2.8, 4.5, 1.9 and 1.6 SD higher, respectively. In contrast, pCS, pCG and IAA concentrations were only higher than controls from CKD Stages 3-4 onwards, but only in CKD Stage 5 for ADMA and HA (z-score 2.6 and 20.2, respectively). Conclusions: This is the first study to establish reference values for a wide range of uraemic toxins in non-dialysis CKD and healthy children. We observed an accumulation of multiple uraemic toxins, each with a particular retention profile according to the different CKD stages.
Background: Chronic kidney disease (CKD) in childhood is poorly explained by routine markers (e.g. urea and creatinine) and is better depicted in adults by other uraemic toxins. This study describes concentrations of representative uraemic toxins in non-dialysis CKD versus healthy children. Methods: In 50 healthy children and 57 children with CKD Stages 1-5 [median estimated glomerular filtration rate 48 (25th-75th percentile 24-71) mL/min/1.73 m2; none on dialysis], serum concentrations of small solutes [symmetric and asymmetric dimethyl-arginine (SDMA and ADMA, respectively)], middle molecules [β2-microglobuline (β2M), complement factor D (CfD)] and protein-bound solutes [p-cresylglucuronide (pCG), hippuric acid (HA), indole-acetic acid (IAA), indoxyl sulphate (IxS), p-cresyl sulphate (pCS) and 3-carboxy-4-methyl-5-propyl-furanpropionic acid (CMPF)] were measured. Concentrations in the CKD group were expressed as z-score relative to controls and matched for age and gender. Results:SDMA, CfD, β2M, IxS, pCS, IAA, CMPF and HA concentrations were higher in the overall CKD group compared with controls, ranging from 1.7 standard deviations (SD) for IAA and HA to 11.1 SD for SDMA. SDMA, CfD, β2M, IxS and CMPF in CKD Stages 1-2 with concentrations 4.8, 2.8, 4.5, 1.9 and 1.6 SD higher, respectively. In contrast, pCS, pCG and IAA concentrations were only higher than controls from CKD Stages 3-4 onwards, but only in CKD Stage 5 for ADMA and HA (z-score 2.6 and 20.2, respectively). Conclusions: This is the first study to establish reference values for a wide range of uraemic toxins in non-dialysis CKD and healthy children. We observed an accumulation of multiple uraemic toxins, each with a particular retention profile according to the different CKD stages.
Authors: Evelien Snauwaert; Wim Van Biesen; Ann Raes; Els Holvoet; Griet Glorieux; Koen Van Hoeck; Maria Van Dyck; Nathalie Godefroid; Raymond Vanholder; Sanne Roels; Johan Vande Walle; Sunny Eloot Journal: Pediatr Nephrol Date: 2017-09-22 Impact factor: 3.714
Authors: Evelien Snauwaert; Els Holvoet; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Nathalie Godefroid; Saoussen Krid; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J Stefanidis; Maria Van Dyck; Koen Van Hoeck; Laure Collard; Sunny Eloot; Rukshana Shroff Journal: Toxins (Basel) Date: 2019-04-24 Impact factor: 4.546
Authors: Ann Raes; Sunny Eloot; Amina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle Journal: Pediatr Nephrol Date: 2021-01-02 Impact factor: 3.714