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

Ghent University Hospital, 9000 Ghent, Belgium
Department of Data Analysis, Faculty of Psychology and Pedagogy, Ghent University, 9000 Ghent, Belgium
A & P Kyriakou Children’s Hospital, 11527 Athens, Greece
Clinic of Pediatrics, Faculty of Medicine, Vilnius University, 08406 Vilnius, Lithuania
Department of Pediatric Nephrology, Cukurova University, 01330 Adana, Turkey
Department of Pediatric Nephrology, Istanbul University Cerrahpasa School of Medicine, 34096 Istanbul, Turkey
Children’s Dialysis Center, 67098 Strasbourg, France
Department of Pediatric Nephrology, Université Catholique Louvain, 1200 Brussels, Belgium
Hôpital Necker-Enfants Malades, 75015 Paris, France
Department of Nephrology, Kidney Transplantation and Hypertension, Children’s Memorial Health Institute, 04-730 Warsaw, Poland
Pediatric Nephrology Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France
CHU Lille, Service de Néphrologie Pédiatrique, 59000 Lille, France
Center for Pediatrics and Adolescent Medicine, 69120 Heidelberg, Germany
University Children’s Hospital, Belgrade and School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
Department of Pediatric Nephrology, Leuven University Hospital, 3000 Leuven, Belgium
Department of Pediatric Nephrology, Antwerp University, 2650 Antwerp, Belgium
Department of Pediatric Nephrology, CHU Liège, 4000 Liège, Belgium
Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
Author to whom correspondence should be addressed.
Last two authors contributed equally to this work.
Toxins 2019, 11(4), 235;
Received: 28 March 2019 / Revised: 19 April 2019 / Accepted: 19 April 2019 / Published: 24 April 2019
(This article belongs to the Special Issue Disposition of Uremic Toxins: The Challenges in Uremia)
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. View Full-Text
Keywords: chronic kidney disease; end-stage kidney disease; child; uremic toxins; hemodialysis; residual kidney function chronic kidney disease; end-stage kidney disease; child; uremic toxins; hemodialysis; residual kidney function
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Snauwaert, E.; Holvoet, E.; Van Biesen, W.; Raes, A.; Glorieux, G.; Vande Walle, J.; Roels, S.; Vanholder, R.; Askiti, V.; Azukaitis, K.; Bayazit, A.; Canpolat, N.; Fischbach, M.; Godefroid, N.; Krid, S.; Litwin, M.; Obrycki, L.; Paglialonga, F.; Ranchin, B.; Samaille, C.; Schaefer, F.; Schmitt, C.P.; Spasojevic, B.; Stefanidis, C.J.; Van Dyck, M.; Van Hoeck, K.; Collard, L.; Eloot, S.; Shroff, R. Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population. Toxins 2019, 11, 235.

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