Removal of the Protein-Bound Solutes Indican and P-Cresol Sulfate by Peritoneal Dialysis

Pham, Nhat M.; Recht, Natalie S.; Hostetter, Thomas H.; Meyer, Timothy W.

doi:10.2215/cjn.02570607

Cited by 88 publications

(93 citation statements)

References 20 publications

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“…dietary, differences explained the observations. The contribution of peritoneal clearance to the total removal of protein-bound solutes such as indoxyl sulfate was rather limited, confirming earlier data (13,21), which point out that the removal of protein-bound , and renal (panel C) mass removal with APD (automated peritoneal dialysis) versus CAPD (continuous ambulatory peritoneal dialysis) for urea (0.1g/week), creatinine (CREA) (cg/week), UA (uric acid) (cg/week), P (phosphorus) (cg/week), β 2 M (beta-2-microlglobulin) (mg/week), HA (hippuric acid) (cg/week), IS (indoxyl sulfate) (mg/ week), IAA (indole acetic acid) (0.1 mg/week), PCS (p-cresyl sulfate) (mg/week), free HA (cg/week), free IS (mg/week), free IAA (0.1mg/week), free PCS (mg/week), and TP (total protein) (0.1g/week). We observed better phosphate removal during CAPD as compared to higher volume APD, mainly because of improved renal clearance, confirming other literature data (20,22).…”

Section: Discussionsupporting

confidence: 89%

Removal of Different Classes of Uremic Toxins in APD vs CAPD: A Randomized Cross-Over Study

et al. 2015

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Section: Discussionsupporting

confidence: 89%

Removal of Different Classes of Uremic Toxins in APD vs CAPD: A Randomized Cross-Over Study

et al. 2015

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“…Furthermore, aside from renal solute clearance, RKF has been known to be valuable in volume control, middle molecule clearance, and nutritional aspects (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). On the basis of these findings, preservation of adequate RKF has emerged as a pivotal strategy in the treatment of patients on dialysis, because loss of RKF cannot be superseded by increasing dialysis dose.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, RKF increases renal salt and water excretion, mitigating the adverse effect of chronic volume overload (13,14). Greater clearance of middle molecule, including b 2 -microglobulin (B2M), and protein-bound uremic toxins, including p-cresol sulfate and indoxyl sulfate (15)(16)(17)(18)(19), better phosphate control (20,21), nutritional benefit (22,23), and better anemia control (10,21) are also thought to be closely associated with beneficial effect of RKF.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis

Lee

Park

et al. 2017

CJASN

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Background and objectives Residual kidney function can be assessed by simply measuring urine volume, calculating GFR using 24-hour urine collection, or estimating GFR using the proposed equation (eGFR). We aimed to investigate the relative prognostic value of these residual kidney function parameters in patients on dialysis.Design, setting, participants, & measurements Using the database from a nationwide prospective cohort study, we compared differential implications of the residual kidney function indices in 1946 patients on dialysis at 36 dialysis centers in Korea between August 1, 2008 and December 31, 2014. Residual GFR calculated using 24-hour urine collection was determined by an average of renal urea and creatinine clearance on the basis of 24-hour urine collection. eGFR-urea, creatinine and eGFR b 2 -microglobulin were calculated from the equations using serum urea and creatinine and b 2 -microglobulin, respectively. The primary outcome was all-cause death.Results During a mean follow-up of 42 months, 385 (19.8%) patients died. In multivariable Cox analyses, residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.98; 95% confidence interval, 0.95 to 0.99) were independently associated with all-cause mortality. In 1640 patients who had eGFR b 2 -microglobulin data, eGFR b 2 -microglobulin (hazard ratio, 0.98; 95% confidence interval, 0.96 to 0.99) was also significantly associated with all-cause mortality as well as residual urine volume (hazard ratio, 0.96 per 0.1-L/d higher volume; 95% confidence interval, 0.94 to 0.98) and GFR calculated using 24-hour urine collection (hazard ratio, 0.97; 95% confidence interval, 0.95 to 0.99). When each residual kidney function index was added to the base model, only urine volume improved the predictability for all-cause mortality (net reclassification index =0.11, P=0.01; integrated discrimination improvement =0.01, P=0.01).Conclusions Higher residual urine volume was significantly associated with a lower risk of death and exhibited a stronger association with mortality than GFR calculated using 24-hour urine collection and eGFR-urea, creatinine. These results suggest that determining residual urine volume may be beneficial to predict patient survival in patients on dialysis.

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“…Renal clearance might contribute up to 80% of total clearance of PCS in PD patients (6). Surprisingly, in a recent cross-sectional study involving 34 PD patients, Pham et al (7) reported that serum concentrations of PCS were similar in anuric and non-anuric patients and that serum concentrations of IndS were modestly increased in anuric patients only. The authors raised the hypothesis that lower PCS and IndS generation rates were obscuring the consequences of decreased renal clearance.…”

mentioning

confidence: 97%

Serum Concentrations of p-Cresyl Sulfate and Indoxyl Sulfate, but Not Inflammatory Markers, Increase in Incident Peritoneal Dialysis Patients in Parallel with Loss of Residual Renal Function

Viaene¹,

Meijers²,

Vanrenterghem³

et al. 2015

Perit Dial Int

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♦ Background: High serum concentrations of the proteinbound uremic retention solutes p-cresyl sulfate (PCS) and indoxyl sulfate (IndS) and inflammation are associated with increased cardiovascular morbidity and mortality in chronic kidney disease. Renal clearance contributes to up to 80% of the total clearance of PCS and IndS in peritoneal dialysis (PD) patients. Cross-sectional studies evaluating the impact of residual renal function (RRF) on serum concentrations of PCS, IndS, and circulating inflammatory markers have yielded conflicting results. ♦ Methods: To clarify this issue, we carried out a prospective observational cohort study in incident PD patients (n = 35; 19 men; mean age: 55 ± 17 years). Midday blood samples were collected and analyzed for total serum PCS, IndS, C-reactive protein, and high-sensitivity interleukin 6. Peritoneal and renal clearances were calculated from urine and dialysate collections, and RRF was calculated as the mean of renal urea nitrogen and creatinine clearances. Patients were assessed 1, 6, 12, and 24 months after PD start. Differences between time points were analyzed using linear mixed models (LMMs). ♦ Results: Residual renal function declined significantly over time (LMM p < 0.0001). Peritoneal clearances of both toxins tended to increase, but did not compensate for the declining renal clearances. Serum concentrations of PCS and IndS increased significantly over time (LMM p = 0.01; p = 0.0009). In contrast, total mass removal of both toxins remained stable. Circulating inflammatory markers did not change over time. ♦ Conclusions: Our data indicate that serum concentrations of PCS and IndS, but not inflammatory markers, increase in incident PD patients in parallel with loss of RRF.

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Removal of the Protein-Bound Solutes Indican and P-Cresol Sulfate by Peritoneal Dialysis

Cited by 88 publications

References 20 publications

Removal of Different Classes of Uremic Toxins in APD vs CAPD: A Randomized Cross-Over Study

Removal of Different Classes of Uremic Toxins in APD vs CAPD: A Randomized Cross-Over Study

Prognostic Value of Residual Urine Volume, GFR by 24-hour Urine Collection, and eGFR in Patients Receiving Dialysis

Serum Concentrations of p-Cresyl Sulfate and Indoxyl Sulfate, but Not Inflammatory Markers, Increase in Incident Peritoneal Dialysis Patients in Parallel with Loss of Residual Renal Function

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