The Removal of Uremic Solutes by Peritoneal Dialysis

Meyer, Timothy W.; Bargman, Joanne M.

doi:10.1681/asn.0000000000000211

JASN

2023

DOI: 10.1681/asn.0000000000000211

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The Removal of Uremic Solutes by Peritoneal Dialysis

Timothy W. Meyer

Joanne M. Bargman

Abstract: Peritoneal dialysis is now commonly prescribed to achieve target clearances for urea or creatinine. The International Society for Peritoneal Dialysis has proposed however that such targets should no longer be imposed. The Society's new guidelines suggest rather that the peritoneal dialysis prescription should be adjusted to achieve well being in individual patients. The relaxation of treatment targets could allow increased use of peritoneal dialysis. Measurement of solute levels in patients receiving dialysis … Show more

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2024

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Cited by 3 publications

References 68 publications

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Peritoneal and renal DKK3 clearance in peritoneal dialysis

Ehleiter,

Miranda,

Boes

et al. 2024

BMC Nephrol

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Background Urinary Dickkopf 3 (DKK3) excretion is a recently established biomarker of renal functional development. Its excretion into the peritoneal cavity has not been reported. We here studied DKK3 in peritoneal dialysis. Methods DKK3 was assessed in serum, urine and dialysate in a prevalent adult peritoneal dialysis cohort and its concentration analyzed in relation to creatinine and clinical characteristics. Results Highest DKK3 concentrations were found in serum, followed by urine. Dialysate concentrations were significantly lower. Dialysate DKK3 correlated with both other compartments. Serum, dialysate and urine values were stable during three months of follow-up. Continuous ambulatory dialysis (CAPD) but not cycler-assisted peritoneal dialysis (CCPD) volume-dependently increased peritoneal DKK3 in relation to creatinine. RAAS blockade significantly decreased urinary, but not serum or peritoneal DKK3. Conclusion Our data provide a detailed characterization of DKK3 in peritoneal dialysis. They support the notion that the RAAS system is essential for renal DKK3 handling.

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Peritoneal and renal DKK3 clearance in peritoneal dialysis

Ehleiter,

Miranda,

Boes

et al. 2024

BMC Nephrol

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Barriers in adequacy goals in peritoneal dialysis:evaluation of a cohort with negative selection bias

Marassi,

Rosa Herculano,

Ghetti

et al. 2024

Bull Dial Domic

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Our study aimed to evaluate PD patients by tracing a sociodemographic profile and jointly evaluating the clinical and laboratory parameters of dialysis adequacy, as well as outcomes. A prospective cohort study in the Juiz de Fora Federal University Hospital dialysis unit in Brazil between July 2021 and July 2022. The sociodemographic, clinical, laboratory data and adherence were assessed. The Short Assessment of Health Literacy for Portuguese-speaking Adults score, a score of perception of social support, a tool for evaluating QoL (SF-12), and Malnutrition Inflammation Score (MIS) were performed. The primary outcomes were death and QoL, whereas technique failure and hospitalization were secondary. Fifty-six patients in automated peritoneal dialysis modality were evaluated (73.2% prevalent and 26.8% incident). The majority were women (61.2 ± 13.9 years old), white, illiterate and with low income. All patients were hypertensive, one-third had diabetes mellitus (DM) and 76.8% were compliant. The definition of goals was the patient stayed within the normal range within 80% of the following time. The adequacy goals of blood pressure (30.4%) and phosphorus (28.6%) were the most difficult to achieve. Among the primary outcomes, the physical component of the SF-12 was negatively associated with higher MIS, and the mental component of the SF-12 was negatively correlated with higher age. There was no significant difference in death as an outcome. The factors that were associated with the achievement of goals were age, previous nephrological follow-up, dementia, DM, and adherence.

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A Systematic Review of Uremic Toxin Concentrations and Cardiovascular Risk Markers in Pediatric Chronic Kidney Disease

Dalpathadu,

Salim,

Wade

et al. 2024

Toxins

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Chronic kidney disease (CKD) can lead to cardiac dysfunction in a condition known as cardiorenal syndrome (CRS). It is postulated that the accumulation of uremic toxins in the bloodstream, as a consequence of declining kidney function, may contribute to these adverse cardiac effects. While CRS in adults has been extensively studied, there is a significant knowledge gap with pediatric patients. Uremic toxin levels in children remain inadequately characterized and quantified compared to adults. This review aims to systematically evaluate the association between uremic toxin concentrations and cardiac changes in pediatric CRS and to examine the impact of different dialysis modalities, specifically hemodialysis and peritoneal dialysis, on uremic toxin clearance and cardiovascular parameters. To address this, we conducted a systematic literature search of PubMed, following PRISMA guidelines. We used the terms “uremic toxins” and “cardiorenal syndrome” with variations in syntax to search for studies discussing the relationship between uremic toxin levels in CKD, the subsequent impact on cardiac parameters, and the emergence of cardiac dysfunction. Full-text articles written in English, conducted on humans aged from birth to 18 years, and published until December 2021 were included. A comprehensive literature search yielded six studies, and their risk of bias was assessed using JBI Critical Appraisal Checklists. Our systematic review is registered on PROSPERO, number CRD42023460072. This synthesis intends to provide an understanding of the role of uremic toxins in pediatric CRS. The findings reveal that pediatric patients with end-stage CKD on dialysis exhibit elevated uremic toxin levels, which are significantly associated with cardiovascular disease parameters. Additionally, the severity of CKD correlated with higher uremic toxin levels. No conclusive evidence was found to support the superiority of either hemodialysis or peritoneal dialysis in terms of uremic toxin clearance or cardiovascular outcomes. More pediatric-specific standardized and longitudinal studies are needed to develop targeted treatments and improve clinical outcomes and the quality of life for affected children.

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The Removal of Uremic Solutes by Peritoneal Dialysis

Cited by 3 publications

References 68 publications

Peritoneal and renal DKK3 clearance in peritoneal dialysis

Peritoneal and renal DKK3 clearance in peritoneal dialysis

Barriers in adequacy goals in peritoneal dialysis:evaluation of a cohort with negative selection bias

A Systematic Review of Uremic Toxin Concentrations and Cardiovascular Risk Markers in Pediatric Chronic Kidney Disease

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