Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population

Snauwaert E., Holvoet E., Van Biesen W., Raes A., Glorieux G., Vande Walle J., ...More

TOXINS, vol.11, no.4, 2019 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 11 Issue: 4
  • Publication Date: 2019
  • Doi Number: 10.3390/toxins11040235
  • Title of Journal : TOXINS
  • Keywords: chronic kidney disease, end-stage kidney disease, child, uremic toxins, hemodialysis, residual kidney function, PROTEIN-BOUND SOLUTES, PERITONEAL-DIALYSIS, RENAL-FUNCTION, SERUM CONCENTRATIONS, ALBUMIN-BINDING, INDOXYL SULFATE, CHILDREN, ACCUMULATION, MORTALITY, RISK


Protein-bound uremic toxins (PBUTs) play a role in the multisystem disease that children on hemodialysis (HD) are facing, but little is known about their levels and protein binding (%PB). In this study, we evaluated the levels and %PB of six PBUTs cross-sectionally in a large pediatric HD cohort (n = 170) by comparing these with healthy and non-dialysis chronic kidney disease (CKD) stage 4-5 (n = 24) children. In parallel 2-microglobulin (2M) and uric acid (UA) were evaluated. We then explored the impact of age and residual kidney function on uremic toxin levels and %PB using analysis of covariance and Spearman correlation coefficients (r(s)). We found higher levels of 2M, p-cresyl glucuronide (pCG), hippuric acid (HA), indole acetic acid (IAA), and indoxyl sulfate (IxS) in the HD compared to the CKD4-5 group. In the HD group, a positive correlation between age and pCG, HA, IxS, and pCS levels was shown. Residual urine volume was negatively correlated with levels of 2M, pCG, HA, IAA, IxS, and CMPF (r(s) -0.2 to -0.5). In addition, we found overall lower %PB of PBUTs in HD versus the CKD4-5 group, and showed an age-dependent increase in %PB of IAA, IxS, and pCS. Furhtermore, residual kidney function was overall positively correlated with %PB of PBUTs. In conclusion, residual kidney function and age contribute to PBUT levels and %PB in the pediatric HD population.