Middle molecule and small protein removal in children on peritoneal dialysis

Montini, Giovanni; Amici, Gianpaolo; Milan, Sabrina; Mussap, Michele; Naturale, Mauro; Rätsch, Ilse-Maria; Ammenti, Anita; Sorino, Palma; Verrina, Enrico; Andreetta, Barbara; Zacchello, Graziella

doi:10.1046/j.1523-1755.2002.00216.x

Cited by 49 publications

(30 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The peritoneal clearance of molecules decreases with increasing molecular size [11,12], whereas the contribution of renal clearance increases accordingly. However, a recent cross-over study comparing high-flow CCPD and standard CAPD did not observe any significant differences in peritoneal substrate clearances for molecules up to a mass of beta 2 -microglobuline (11.8 kDa, [13]).…”

Section: Introductionmentioning

confidence: 98%

Comparison of Peritoneal Low-Molecular-Weight-Protein-Removal in CCPD and CAPD Patients Based on C-Terminal Agrin Fragment Clearance

Steubl

Roos

Hettwer

et al. 2016

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: This study compares the peritoneal elimination of the low-molecular-weight-protein (LMWP) C-terminal agrin fragment (tCAF, size 22 kDa), a promising biomarker for kidney function, in continuous cycling peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD). Methods: 103 sets of serum, 24h-urine and dialysate samples were obtained in 15 CCPD (63 sets) and 11 CAPD (40 sets) patients. Total, renal and peritoneal substrate removals/clearances were measured/calculated for tCAF, creatinine, blood-urea-nitrogen (BUN), cystatin C and albumin and correlated with the peritoneal transport type. Results: Serum und urine concentrations of all biomarkers did not differ between both groups, urinary substrate removal was higher in CAPD patients for all biomarkers due to better residual renal function. Peritoneal substrate removal of tCAF and albumin were significantly higher in CAPD (tCAF: 35.3 vs. 19.3 µg/d, p<0.001; albumin: 4.3 vs. 3.7 g/d, p=0.001), whereas cystatin C and creatinine did not differ between CAPD and CCPD (cystatin: 7.7 vs. 6.1 mg/d, p=0.08, creatinine: 423.9 vs. 456.7 mg/d, p=0.241). BUN was better removed by CCPD (4846.6 vs. 3393.4 mg/d, p<0.001). CAPD patients with high-transporter characteristics had a higher peritoneal tCAF removal compared to high-average-transporters (49.8 vs. 28.4 µg/d, p<0.001), no differences could be detected in CCPD patients between these groups. CAPD patients using icodextrin twice/day had higher peritoneal clearance of tCAF compared to once daily (4.4 vs. 2.8 l/wk/1.73 m² body-surface-area, p<0.001). Conclusions: CAPD was superior to CCPD concerning peritoneal tCAF removal. This finding was pronounced in high-transporters and CAPD patients using icodextrin twice daily.

show abstract

Section: Introductionmentioning

confidence: 98%

Comparison of Peritoneal Low-Molecular-Weight-Protein-Removal in CCPD and CAPD Patients Based on C-Terminal Agrin Fragment Clearance

Steubl

Roos

Hettwer

et al. 2016

Kidney Blood Press Res

View full text Add to dashboard Cite

show abstract

“…These results can be explained by the relationship between the renal and peritoneal Kt/V urea and the weekly renal and peritoneal C cr , where decreasing renal elimination is associated with increased peritoneal clearance. Montini et al [14] demonstrated that in children with residual diuresis, CysC is removed mainly by renal creatinine clearance (62.8%) and that plasma CysC is significantly correlated with renal inulin clearance. These researchers also showed that solutes removed during PD tended to decrease with an increase in molecular weight.…”

Section: Discussionmentioning

confidence: 99%

“…In the kidney, it is freely filtered through the glomeruli and then catabolized in the proximal tubules; consequently, it is not normally secreted [13]. The intermediate size of CysC makes it dialyzable and a "middle molecule" marker of toxin removal [14]. Previous studies have suggested that serum CysC might be a superior marker for the GFR than creatinine, because it is independent of age and other factors, such as height and muscle mass [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Serum cystatin C for estimation of residual renal function in children on peritoneal dialysis

et al. 2010

View full text Add to dashboard Cite

Residual renal function (RRF) is an important parameter in the management of patients on chronic dialysis. The aim of this cross-sectional study was to determine the efficacy of serum cystatin C (CysC) for RRF estimation in 20 children (16 boys, 4 girls; median age 13.4 years) undergoing peritoneal dialysis (PD). For studies of correlation with serum CysC, the average of creatinine clearance rate (Ccr) and urea clearance rate (Curea), Kt/Vurea, and weekly Ccr were evaluated as parameters reflecting RRF. The serum CysC level was found to be negatively correlated with urine volume (r=-0.717, P<0.001), average of Ccr and Curea (r=-0.851, P<0.001), total and renal weekly Ccr (r=-0.795, P<0.001; r=-0.845, P<0.001, respectively), and renal Kt/Vurea (r=-0.793, P<0.001) and positively correlated with peritoneal weekly Ccr (r=0.738, P<0.001) and peritoneal Kt/Vurea (r=0.785, P<0.001). There was no significant association with total Kt/Vurea (r=-0.335, P=0.148). In non-anuric group of patients, serum CysC had no link to peritoneal Kt/Vurea (r=0.573, P=0.066), but was negatively correlated with renal Kt/Vurea (r=-0.609, P=0.047). In the multiple regression analysis, renal Kt/Vurea significantly contributed to log CysC concentration rather than peritoneal Kt/Vurea. The results of this study suggest that serum CysC could be an appropriate marker for RRF, independent of total and peritoneal Kt/Vurea.

show abstract

“…Middle-sized molecules and phosphate removal is slow and equilibration with plasma levels only occurs with a long dwell [207]. Removal of middle-sized molecules and low-molecular-weight proteins, such as b 2 -microglobulin and leptin, mainly depends on residual renal function [183,21]. Moreover, an increasing restriction coefficient was reported for macromolecules with time on chronic PD, which is associated with increased size selectivity and a reduced peritoneal permeability for higher-molecular-weight solutes [32].…”

Section: Clearance Of Middle-sized Molecules and Phosphatementioning

confidence: 99%

Peritoneal Dialysis in Children

Patel

Kv³

et al. 2015

Pediatric Nephrology

Self Cite

View full text Add to dashboard Cite

In children with chronic kidney disease stage 5D peritoneal dialysis (PD) remains the dialysis modality most commonly prescribed, especially as automated PD. Nowadays it can be started from the first days of life on, and applied even to some preterm babies. This chapter gives an overview on PD membrane ultrastructure and function, on technical prerequistes of PD, on optimal PD prescription and on specific treatment targets and tools to monitor efficacy. It describes PD related infectious and noninfectious complications, long term peritoneal and systemic sequelae and current state of the art of how these can be mitigated or even be prevented.

show abstract

Middle molecule and small protein removal in children on peritoneal dialysis

Cited by 49 publications

References 18 publications

Comparison of Peritoneal Low-Molecular-Weight-Protein-Removal in CCPD and CAPD Patients Based on C-Terminal Agrin Fragment Clearance

Comparison of Peritoneal Low-Molecular-Weight-Protein-Removal in CCPD and CAPD Patients Based on C-Terminal Agrin Fragment Clearance

Serum cystatin C for estimation of residual renal function in children on peritoneal dialysis

Peritoneal Dialysis in Children

Contact Info

Product

Resources

About