Sat-241 Erythrocyte Glutathione Transferase: A Promising Marker for Hemodialysis Adequacy

Abstract

to examine: (1) trends of IDWG among patients in relation to different variables and comorbidities e.g. age, hypertension, diabetes, CV disease...etc.; (2) associations of high IDWG with frequency of hospitalization due to systemic volume overload and the need for extra dialysis sessions, and (3) the impact of high IDWG on the frequency of intradialytic hypotension (IDH). Methods: One hundred and twenty maintenance HD patients were enrolled in this study. All patients had been receiving HD for at least 3 months, on a 4 hour, thrice weekly basis. The data collected included; age, gender, duration on HD (in months), pre-and post-HD body weights (on 3 successive sessions), pre-and post-HD blood pressure (BP) measurements (on 3 successive sessions), the type of vascular access and the average blood flow rate, dialysis efficiency (based on average Kt/V), and the presence or absence of residual kidney function.The presence of various comorbidities has been recorded including; diabetes, hypertension, coronary artery and peripheral vascular diseases, heart failure, cerebrovascular disease, and other disorders. The estimated IDWG was calculated based on the average between pre-and post-dialysis weights that were recorded on 3 consecutive dialysis sessions. The estimated IDWG was expressed in kilograms and as a percentage of the patients' dry weight. We considered an estimated average IDWG of 4% as a cutoff value between low and high IDWG. We defined IDH as the drop of systolic blood pressure of 20 mmHg or more during HD compared to the predialysis blood pressure and/or a systolic blood pressure that is less than 90 mmHg. Results: We have recorded that 50.0% of those younger than 55 years had IDWG $ 4%. On the other hand, only 31.7% of those aged 55 years or more had IDWG $ 4% (p¼0.041). There was no significant gender difference regarding IDWG. Among those who had IDWG $ 4%, 81% of these patients had at least one hospital admission due to volume overload or the need for extra HD session(s). On the other hand, only 19% of those having IDWG < 4% had been admitted or got extra HD sessions (p<0.001). Of those who were admitted (over 12 months) due to volume overload; 74.1 % had IDWG $ 4%, while 25.9% had IDWG < 4% (p< 0.001). Regarding IDH, 87% of patients having IDWG $ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG < 4% had one episode of IDH/week (p<0.001). When analyzing those who had at least one IDH episode/ week; 72.9% of them had IDWG $ 4%, while only 27.1% had IDWG < 4% (p<0.001).Introduction: Identification of new clinical indicators for ideal dialysis is an interest. Erythrocyte glutathione transferase (e-GST) is non-dialyzable enzyme compartmentalized in the red cells. It may act as ligandins by binding and sequestering a variety of small or large toxic compounds and peptides. The aim of the study was to verify whether e-GST is able to assess hemodialysis adequacy among different treatment modalities, as a complementary to the Kt/V urea parameter. Methods: This cross secti...

Assessment of Clinical Utility of Erythrocyte Glutathione Transferase as Biomarker of Hemodialysis Adequacy in pediatrics

“…In our study The post HD analysis of E-GST level showed significant difference between control and conventional HD (p-value 0.001&0.001) respectively This agreed with [7] that showed that the post HD analysis of E-GST level in Post hoc analysis showed significant difference between control and both conventional and HDF patients (P <0.0001, 0.0001) respectively while no significant differences between conventional HD and HDF patients P value (0.061) were observed.…”

“…That agreed with (7)who showed that Serum e-GST can predict inadequate dialysis at cut off value>14 ng/ml with area under curve (AUC) 0.871, sensitivity 95%, specificity 60%, PP.V 70.4% and NPV 92.3%. The marker e-Gst was significantly high in patients on conventional HD and HDF (mean _SD 18.35_5.61, 15.20_4.40) respectively compared with control subjects (mean _SD 2.80_1.36) P value <0.0001.…”

“…In our study the patients on conventional HD as regard blood pressure that normotensive patients (13) (52%) hypertension [7] (28%) patients hypotensive patients (5)(20%) respectively.…”

“…Erythrocyte glutathione transferase (e-GST) is nondialyzable enzyme compartmentalized in the red cells. It may act as ligandins by binding and sequestering a variety of small or large toxic compounds and peptides [7]. E-GST may be an innovative tool able to measure the efficiency of multiple dialysis sessions, its expression is linked not only to the quantitative level or size of blood toxins, but to their own specific toxicity, it may be complementary or alternative to the Kt/V urea [8].…”