Lakshmi L Ganesan1,2, Frank J O'Brien3, Tammy L Sirich4,5, Natalie S Plummer4,5, Rita Sheth1, Cecile Fajardo6,7, Paul Brakeman8, Scott M Sutherland2, Timothy W Meyer9,5. 1. Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California. 2. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California. 3. Department of Medicine, Washington University, St. Louis, Missouri. 4. Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California. 5. Department of Medicine, Stanford University, Palo Alto, California. 6. Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California. 7. Department of Pediatrics, University of Southern California, Los Angeles, California. 8. Department of Pediatrics, University of California, San Francisco, California. 9. Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California twmeyer@stanford.edu.
Abstract
BACKGROUND AND OBJECTIVES: Residual native kidney function confers health benefits in patients on dialysis. It can facilitate control of extracellular volume and inorganic ion concentrations. Residual kidney function can also limit the accumulation of uremic solutes. This study assessed whether lower plasma concentrations of uremic solutes were associated with residual kidney function in pediatric patients on peritoneal dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Samples were analyzed from 29 pediatric patients on peritoneal dialysis, including 13 without residual kidney function and ten with residual kidney function. Metabolomic analysis by untargeted mass spectrometry compared plasma solute levels in patients with and without residual kidney function. Dialytic and residual clearances of selected solutes were also measured by assays using chemical standards. RESULTS: Metabolomic analysis showed that plasma levels of 256 uremic solutes in patients with residual kidney function averaged 64% (interquartile range, 51%-81%) of the values in patients without residual kidney function who had similar total Kt/Vurea. The plasma levels were significantly lower for 59 of the 256 solutes in the patients with residual kidney function and significantly higher for none. Assays using chemical standards showed that residual kidney function provides a higher portion of the total clearance for nonurea solutes than it does for urea. CONCLUSIONS: Concentrations of many uremic solutes are lower in patients on peritoneal dialysis with residual kidney function than in those without residual kidney function receiving similar treatment as assessed by Kt/Vurea.
BACKGROUND AND OBJECTIVES: Residual native kidney function confers health benefits in patients on dialysis. It can facilitate control of extracellular volume and inorganic ion concentrations. Residual kidney function can also limit the accumulation of uremic solutes. This study assessed whether lower plasma concentrations of uremic solutes were associated with residual kidney function in pediatric patients on peritoneal dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Samples were analyzed from 29 pediatric patients on peritoneal dialysis, including 13 without residual kidney function and ten with residual kidney function. Metabolomic analysis by untargeted mass spectrometry compared plasma solute levels in patients with and without residual kidney function. Dialytic and residual clearances of selected solutes were also measured by assays using chemical standards. RESULTS: Metabolomic analysis showed that plasma levels of 256 uremic solutes in patients with residual kidney function averaged 64% (interquartile range, 51%-81%) of the values in patients without residual kidney function who had similar total Kt/Vurea. The plasma levels were significantly lower for 59 of the 256 solutes in the patients with residual kidney function and significantly higher for none. Assays using chemical standards showed that residual kidney function provides a higher portion of the total clearance for nonurea solutes than it does for urea. CONCLUSIONS: Concentrations of many uremic solutes are lower in patients on peritoneal dialysis with residual kidney function than in those without residual kidney function receiving similar treatment as assessed by Kt/Vurea.
Authors: Frank J O'Brien; Tammy L Sirich; Abigail Taussig; Enrica Fung; Lakshmi L Ganesan; Natalie S Plummer; Paul Brakeman; Scott M Sutherland; Timothy W Meyer Journal: Pediatr Nephrol Date: 2019-11-14 Impact factor: 3.714
Authors: Fabian Termorshuizen; Johanna C Korevaar; Friedo W Dekker; Jeannette G van Manen; Elisabeth W Boeschoten; Raymond T Krediet Journal: Am J Kidney Dis Date: 2003-06 Impact factor: 8.860
Authors: Ke Wang; Michelle Nguyen; Yan Chen; Andrew N Hoofnagle; Jessica O Becker; Leila R Zelnick; John Kundzins; Anne Goodling; Jonathan Himmelfarb; Bryan Kestenbaum Journal: Clin J Am Soc Nephrol Date: 2020-03-09 Impact factor: 8.237
Authors: Eugene P Rhee; Sushrut S Waikar; Casey M Rebholz; Zihe Zheng; Regis Perichon; Clary B Clish; Anne M Evans; Julian Avila; Michelle R Denburg; Amanda Hyre Anderson; Ramachandran S Vasan; Harold I Feldman; Paul L Kimmel; Josef Coresh Journal: Clin J Am Soc Nephrol Date: 2018-12-20 Impact factor: 10.614