Protein-bound uremic toxins in hemodialysis patients relate to residual kidney function, are not influenced by convective transport, and do not relate to outcome

Autor: van Gelder, Maaike K, Middel, Igor R, Vernooij, Robin W M, Bots, Michiel L, Verhaar, Marianne C, Masereeuw, Rosalinde, Grooteman, Muriel P, Nubé, Menso J, van den Dorpel, M A, Blankestijn, Peter J, Rookmaaker, Maarten B, Gerritsen, Karin G F, Afd Pharmacology, Pharmacology
Přispěvatelé: Afd Pharmacology, Pharmacology, Nephrology, ACS - Diabetes & metabolism
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Time Factors
Health
Toxicology and Mutagenesis
medicine.medical_treatment
030232 urology & nephrology
lcsh:Medicine
030204 cardiovascular system & hematology
Toxicology
Kidney
chemistry.chemical_compound
0302 clinical medicine
residual kidney function
Medicine
convection
Netherlands
education.field_of_study
hemodialysis
End-stage kidney disease
Blood Proteins
Middle Aged
Treatment Outcome
Cardiovascular Diseases
Female
Hemodialysis
Protein Binding
medicine.medical_specialty
Population
Renal function
Hemodiafiltration
Article
Excretion
03 medical and health sciences
Renal Dialysis
Internal medicine
Protein-bound uremic toxin
Humans
education
Dialysis
Aged
Toxins
Biological
Uremia
hemodiafiltration
business.industry
lcsh:R
Hippuric acid
medicine.disease
Renal Elimination
Endocrinology
chemistry
Kidney Failure
Chronic
business
Kynurenine
Biomarkers
Kidney disease
Zdroj: van Gelder, M K, Middel, I R, Vernooij, R W M, Bots, M L, Verhaar, M C, Masereeuw, R, Grooteman, M P, Nubé, M J, van den Dorpel, M A, Blankestijn, P J, Rookmaaker, M B & Gerritsen, K G F 2020, ' Protein-bound uremic toxins in hemodialysis patients relate to residual kidney function, are not influenced by convective transport, and do not relate to outcome ', Toxins, vol. 12, no. 4, 234 . https://doi.org/10.3390/toxins12040234
Toxins
Volume 12
Issue 4
Toxins, 12(4). MDPI AG
Toxins, 12(4):234. Multidisciplinary Digital Publishing Institute
Toxins, Vol 12, Iss 234, p 234 (2020)
ISSN: 2072-6651
DOI: 10.3390/toxins12040234
Popis: Protein-bound uremic toxins (PBUTs) are predominantly excreted by renal tubular secretion and hardly removed by traditional hemodialysis (HD). Accumulation of PBUTs is proposed to contribute to the increased morbidity and mortality of patients with end-stage kidney disease (ESKD). Preserved PBUT excretion in patients with residual kidney function (RKF) and/or increased PBUT clearance with improved dialysis techniques might improve the prognosis of patients with ESKD. The aims of this study are to explore determinants of PBUTs in HD patients, and investigate whether hemodiafiltration (HDF) lowers PBUT plasma concentrations, and whether PBUTs are related to the outcome. Predialysis total plasma concentrations of kynurenine, kynurenic acid, indoxyl sulfate, indole-3-acetic acid, p-cresyl sulfate, p-cresyl glucuronide, and hippuric acid were measured by UHPLC-MS at baseline and after 6 months of follow-up in the first 80 patients participating in the CONvective TRAnsport Study (CONTRAST), a randomized controlled trial that compared the effects of online HDF versus low-flux HD on all-cause mortality and new cardiovascular events. RKF was inversely related to kynurenic acid (p <
0.001), indoxyl sulfate (p = 0.001), indole-3-acetic acid (p = 0.024), p-cresyl glucuronide (p = 0.004) and hippuric acid (p <
0.001) plasma concentrations. Only indoxyl sulfate decreased by 8.0% (&minus
15.3 to 34.6) in patients treated with HDF and increased by 11.9% (&minus
15.4 to 31.9) in HD patients after 6 months of follow-up (HDF vs. HD: p = 0.045). No independent associations were found between PBUT plasma concentrations and either risk of all-cause mortality or new cardiovascular events. In summary, in the current population, RKF is an important determinant of PBUT plasma concentrations in HD patients. The addition of convective transport did not consistently decrease PBUT plasma concentrations and no relation was found between PBUTs and cardiovascular endpoints.
Databáze: OpenAIRE
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