Tags

Type your tag names separated by a space and hit enter

Does the adequacy parameter Kt/V(urea) reflect uremic toxin concentrations in hemodialysis patients?
PLoS One. 2013; 8(11):e76838.Plos

Abstract

Hemodialysis aims at removing uremic toxins thus decreasing their concentrations. The present study investigated whether Kt/V(urea), used as marker of dialysis adequacy, is correlated with these concentrations. Predialysis blood samples were taken before a midweek session in 71 chronic HD patients. Samples were analyzed by colorimetry, HPLC, or ELISA for a broad range of uremic solutes. Solute concentrations were divided into four groups according to quartiles of Kt/V(urea), and also of different other parameters with potential impact, such as age, body weight (BW), Protein equivalent of Nitrogen Appearance (PNA), Residual Renal Function (RRF), and dialysis vintage. Dichotomic concentration comparisons were performed for gender and Diabetes Mellitus (DM). Analysis of Variance in quartiles of Kt/V(urea) did not show significant differences for any of the solute concentrations. For PNA, however, concentrations showed significant differences for urea (P<0.001), uric acid (UA), p-cresylsulfate (PCS), and free PCS (all P<0.01), and for creatinine (Crea) and hippuric acid (HA) (both P<0.05). For RRF, concentrations varied for β₂-microglobulin (P<0.001), HA, free HA, free indoxyl sulfate, and free indole acetic acid (all P<0.01), and for p-cresylglucuronide (PCG), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), free PCS, and free PCG (all P<0.05). Gender and body weight only showed differences for Crea and UA, while age, vintage, and diabetes mellitus only showed differences for one solute concentration (UA, UA, and free PCS, respectively). Multifactor analyses indicated a predominant association of concentration with protein intake and residual renal function. In conclusion, predialysis concentrations of uremic toxins seem to be dependent on protein equivalent of nitrogen appearance and residual renal function, and not on dialysis adequacy as assessed by Kt/V(urea). Efforts to control intestinal load of uremic toxin precursors by dietary or other interventions, and preserving RRF seem important approaches to decrease uremic solute concentration and by extension their toxicity.

Authors+Show Affiliations

Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24236005

Citation

Eloot, Sunny, et al. "Does the Adequacy Parameter Kt/V(urea) Reflect Uremic Toxin Concentrations in Hemodialysis Patients?" PloS One, vol. 8, no. 11, 2013, pp. e76838.
Eloot S, Van Biesen W, Glorieux G, et al. Does the adequacy parameter Kt/V(urea) reflect uremic toxin concentrations in hemodialysis patients? PLoS One. 2013;8(11):e76838.
Eloot, S., Van Biesen, W., Glorieux, G., Neirynck, N., Dhondt, A., & Vanholder, R. (2013). Does the adequacy parameter Kt/V(urea) reflect uremic toxin concentrations in hemodialysis patients? PloS One, 8(11), e76838. https://doi.org/10.1371/journal.pone.0076838
Eloot S, et al. Does the Adequacy Parameter Kt/V(urea) Reflect Uremic Toxin Concentrations in Hemodialysis Patients. PLoS One. 2013;8(11):e76838. PubMed PMID: 24236005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does the adequacy parameter Kt/V(urea) reflect uremic toxin concentrations in hemodialysis patients? AU - Eloot,Sunny, AU - Van Biesen,Wim, AU - Glorieux,Griet, AU - Neirynck,Nathalie, AU - Dhondt,Annemieke, AU - Vanholder,Raymond, Y1 - 2013/11/13/ PY - 2012/12/12/received PY - 2013/08/31/accepted PY - 2013/11/16/entrez PY - 2013/11/16/pubmed PY - 2014/9/3/medline SP - e76838 EP - e76838 JF - PloS one JO - PLoS One VL - 8 IS - 11 N2 - Hemodialysis aims at removing uremic toxins thus decreasing their concentrations. The present study investigated whether Kt/V(urea), used as marker of dialysis adequacy, is correlated with these concentrations. Predialysis blood samples were taken before a midweek session in 71 chronic HD patients. Samples were analyzed by colorimetry, HPLC, or ELISA for a broad range of uremic solutes. Solute concentrations were divided into four groups according to quartiles of Kt/V(urea), and also of different other parameters with potential impact, such as age, body weight (BW), Protein equivalent of Nitrogen Appearance (PNA), Residual Renal Function (RRF), and dialysis vintage. Dichotomic concentration comparisons were performed for gender and Diabetes Mellitus (DM). Analysis of Variance in quartiles of Kt/V(urea) did not show significant differences for any of the solute concentrations. For PNA, however, concentrations showed significant differences for urea (P<0.001), uric acid (UA), p-cresylsulfate (PCS), and free PCS (all P<0.01), and for creatinine (Crea) and hippuric acid (HA) (both P<0.05). For RRF, concentrations varied for β₂-microglobulin (P<0.001), HA, free HA, free indoxyl sulfate, and free indole acetic acid (all P<0.01), and for p-cresylglucuronide (PCG), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), free PCS, and free PCG (all P<0.05). Gender and body weight only showed differences for Crea and UA, while age, vintage, and diabetes mellitus only showed differences for one solute concentration (UA, UA, and free PCS, respectively). Multifactor analyses indicated a predominant association of concentration with protein intake and residual renal function. In conclusion, predialysis concentrations of uremic toxins seem to be dependent on protein equivalent of nitrogen appearance and residual renal function, and not on dialysis adequacy as assessed by Kt/V(urea). Efforts to control intestinal load of uremic toxin precursors by dietary or other interventions, and preserving RRF seem important approaches to decrease uremic solute concentration and by extension their toxicity. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/24236005/Does_the_adequacy_parameter_Kt/V_urea__reflect_uremic_toxin_concentrations_in_hemodialysis_patients DB - PRIME DP - Unbound Medicine ER -