A plea for more uremic toxin research in children with chronic kidney disease

Snauwaert, Evelien; Biesen, Wim Van; Raes, Ann; Glorieux, Griet; Vanholder, Raymond; Walle, Johan Vande; Eloot, Sunny

doi:10.1007/s00467-018-3920-8

Cited by 10 publications

(4 citation statements)

References 28 publications

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“…Children in end-stage kidney disease (ESKD) are facing a multisystem disease with lifelong consequences, such as frequent hospitalizations, decreased quality of life, and a short expected lifetime compared to healthy children [1,2,3]. Several factors contribute to the systemic nature and the accompanying high mortality and morbidity faced by children in ESKD: e.g., deterioration of renal endocrine and homeostatic function, problems and/or consequences related to kidney disease and its treatment, and the accumulation of toxic organic metabolites (i.e., uremic toxins).…”

Section: Introductionmentioning

confidence: 99%

“…Several factors contribute to the systemic nature and the accompanying high mortality and morbidity faced by children in ESKD: e.g., deterioration of renal endocrine and homeostatic function, problems and/or consequences related to kidney disease and its treatment, and the accumulation of toxic organic metabolites (i.e., uremic toxins). Based on studies in the adult ESKD population, the accumulation of uremic toxins is considered a major determinant in the pathophysiology of ESKD, nevertheless, no studies in the pediatric population have been performed [2,4,5,6]. To date, more than 150 uremic solutes have been described, which can be divided into three categories, based on their physicochemical characteristics explaining their behavior during dialysis: small, water-soluble compounds; larger, middle molecules; and protein-bound toxins (PBUTs) [7].…”

Section: Introductionmentioning

confidence: 99%

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

Snauwaert

Holvoet

Biesen

et al. 2019

Toxins

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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 β2-microglobulin (β2M) 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 (rs). We found higher levels of β2M, 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 β2M, pCG, HA, IAA, IxS, and CMPF (rs −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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Snauwaert

Holvoet

Biesen

et al. 2019

Toxins

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“…Children and adolescents with kidney disease encounter growth retardation and limitations in mobility and social and educational development that hamper psychological development. This may be worsened by time spent on dialysis, which mostly takes place in the midst of adult patients [ 11 ]. Among older patients, frailty and muscle wasting (sarcopaenia) are common [ 12 ].…”

Section: A Devastating Diseasementioning

confidence: 99%

Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney

Vanholder

Annemans

Bello

et al. 2021

Clinical Kidney Journal

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A brief comprehensive overview is provided of the elements constituting the burden of kidney disease (chronic kidney disease and acute kidney injury). This publication can be used for advocacy emphasizing the importance and urgency of reducing this heavy and rapidly growing burden. Kidney diseases contribute to significant physical limitations, loss of quality of life, emotional and cognitive disorders, social isolation and premature death. Chronic kidney disease affects close to 100 million Europeans with 300 million being at risk, and is projected to become the fifth cause of worldwide death by 2040. Kidney disease also imposes financial burdens given the costs of accessing health care and inability to work. The extrapolated annual cost of all chronic kidney disease is at least as high as that for cancer or diabetes. In addition, dialysis treatment of kidney diseases imposes environmental burdens by necessitating high energy and water consumption and producing plastic waste. Acute kidney injury is associated with further increases of global morbidity, mortality and economic burden. Yet, investment in research for treatment of kidney disease lags behind that of other diseases. This publication is a call for European investment in research for kidney health. The innovations generated should mirror the successful EU actions against cancer over the last 30 years. It is also a plea to nephrology professionals, patients and their families, caregivers, and kidney health advocacy organizations, to draw during the Decade of the Kidney (2020-2030) the attention of authorities to realize changes in understanding, research and treatment of kidney disease.

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“…Major Examples of UT It is crucial to acknowledge that the vast majority of data on UT refers to adult population with CKD. As emphasized by Belgian experts in the field [49], publications strictly focusing on paediatric CKD patients are lacking, while the available knowledge regarding the adults may not be fully translated to younger individuals. Therein, the authors mentioned several relevant disparities between paediatric and adult population, mainly larger body water volume and lower circulating proteins, different dietary needs and intake, the ongoing and unfinished processes of maturation and growth, distinct aetiology of CKD, and relatively longer survival when compared to adults with ESRD.…”

Section: Substance Groupsmentioning

confidence: 99%

Chronic Kidney Disease-Associated Itch (CKD-aI) in Children—A Narrative Review

Reszke

Kiliś‐Pstrusińska

Szepietowski

2021

Toxins

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Chronic kidney disease (CKD) is a condition of widespread epidemiology and serious consequences affecting all organs of the organism and associated with significant mortality. The knowledge on CKD is rapidly evolving, especially concerning adults. Recently, more data is also appearing regarding CKD in children. Chronic itch (CI) is a common symptom appearing due to various underlying dermatological and systemic conditions. CI may also appear in association with CKD and is termed chronic kidney disease-associated itch (CKD-aI). CKD-aI is relatively well-described in the literature concerning adults, yet it also affects children. Unfortunately, the data on paediatric CKD-aI is particularly scarce. This narrative review aims to describe various aspects of CKD-aI with an emphasis on children, based on the available data in this population and the data extrapolated from adults. Its pathogenesis is described in details, focusing on the growing role of uraemic toxins (UTs), as well as immune dysfunction, altered opioid transmission, infectious agents, xerosis, neuropathy and dialysis-associated aspects. Moreover, epidemiological and clinical aspects are reviewed based on the few data on CKD-aI in children, whereas treatment recommendations are proposed as well, based on the literature on CKD-aI in adults and own experience in managing CI in children.

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A plea for more uremic toxin research in children with chronic kidney disease

Cited by 10 publications

References 28 publications

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

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

Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney

Chronic Kidney Disease-Associated Itch (CKD-aI) in Children—A Narrative Review

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