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Plasma pseudouridine levels reflect body size in children on hemodialysis.
Pediatric Nephrology ( IF 3 ) Pub Date : 2019-11-14 , DOI: 10.1007/s00467-019-04369-6
Frank J O'Brien 1 , Tammy L Sirich 2 , Abigail Taussig 2 , Enrica Fung 3 , Lakshmi L Ganesan 4 , Natalie S Plummer 2 , Paul Brakeman 5 , Scott M Sutherland 4 , Timothy W Meyer 2
Affiliation  

BACKGROUND Dialysis in children as well as adults is prescribed to achieve a target spKt/Vurea, where Vurea is the volume of distribution of urea. Waste solute production may however be more closely correlated with body surface area (BSA) than Vurea which rises in proportion with body weight. Plasma levels of waste solutes may thus be higher in smaller patients when targeting spKt/Vurea since they have higher BSA relative to body weight. This study measured levels of pseudouridine (PU), a novel marker solute whose production is closely proportional to BSA, to test whether prescription of dialysis to a target spKt/Vurea results in higher plasma levels of PU in smaller children. METHODS PU and urea nitrogen (ureaN) were measured in plasma and dialysate at the midweek hemodialysis session in 20 pediatric patients, with BSA ranging from 0.65-1.87m2. Mathematical modeling was employed to estimate solute production rates and average plasma solute levels. RESULTS The dialytic clearance (Kd) of PU was proportional to that of ureaN (average KdPU/KdUreaN 0.69 ± 0.13, r2 0.84, p < 0.001). Production of PU rose in proportion with BSA (r2 0.57, p < 0.001). The pretreatment plasma level of PU was significantly higher in smaller children (r2 0.20, p = 0.051) while the pretreatment level of ureaN did not vary with size. CONCLUSIONS Prescribing dialysis based on urea kinetics may leave uremic solutes at higher levels in small children. Measurement of a solute produced proportional to BSA may provide a better index of dialysis adequacy than measurement of urea.

中文翻译:

血浆伪尿苷水平反映了血液透析儿童的体重。

背景技术规定在儿童以及成人中进行透析以达到目标spKt / Vurea,其中Vurea是尿素的分布量。但是,废物溶质的产生可能与比表面积(BSA)更紧密的相关,而不是与脲(Vurea)成正比,而尿素的增加与体重成正比。因此,靶向spKt / Vurea的较小患者的血浆血浆溶质水平可能更高,因为它们相对于体重具有更高的BSA。这项研究测量了假尿苷(PU)的水平,一种新型的标记溶质,其产生量与BSA密切相关,以测试针对目标spKt / Vurea的透析处方是否会导致较小儿童的PU血浆水平更高。方法在20周小儿血液透析期间,对血浆和透析液中的PU和尿素氮(ureaN)进行测定,其BSA范围为0.65-1.87m2。使用数学模型来估计溶质的产生速率和平均血浆溶质水平。结果PU的透析清除率(Kd)与尿素氮的清除率成正比(平均KdPU / KdUreaN 0.69±0.13,r2 0.84,p <0.001)。PU的产量与BSA成比例增长(r2 0.57,p <0.001)。在较小的儿童中,PU的血浆预处理水平明显更高(r2 = 0.20,p = 0.051),而尿素氮的预处理水平并未随大小而变化。结论基于尿素动力学的透析处方可能会使儿童尿毒症溶质的含量更高。与BSA成比例的溶质的测量可以提供比尿素更好的透析充分性指数。结果PU的透析清除率(Kd)与尿素氮的清除率成正比(平均KdPU / KdUreaN 0.69±0.13,r2 0.84,p <0.001)。PU的产量与BSA成比例增长(r2 0.57,p <0.001)。在较小的儿童中,PU的血浆预处理水平明显更高(r2 = 0.20,p = 0.051),而尿素氮的预处理水平并未随大小而变化。结论基于尿素动力学的透析处方可能会使儿童尿毒症溶质的含量更高。与BSA成比例的溶质的测量可以提供比尿素更好的透析充分性指数。结果PU的透析清除率(Kd)与尿素氮的清除率成正比(平均KdPU / KdUreaN 0.69±0.13,r2 0.84,p <0.001)。PU的产量与BSA成比例增长(r2 0.57,p <0.001)。在较小的儿童中,PU的血浆预处理水平明显更高(r2 = 0.20,p = 0.051),而尿素氮的预处理水平并未随大小而变化。结论基于尿素动力学的透析处方可能会使儿童尿毒症溶质的含量更高。与BSA成比例的溶质的测量可以提供比尿素更好的透析充分性指数。在较小的儿童中,PU的血浆预处理水平明显更高(r2 = 0.20,p = 0.051),而尿素氮的预处理水平并未随大小而变化。结论基于尿素动力学的透析处方可能会使儿童尿毒症溶质的含量更高。与BSA成比例的溶质的测量可以提供比尿素更好的透析充分性指数。在较小的儿童中,PU的血浆预处理水平明显更高(r2 = 0.20,p = 0.051),而尿素氮的预处理水平并未随大小而变化。结论基于尿素动力学的透析处方可能会使儿童尿毒症溶质的含量更高。与BSA成比例的溶质的测量可以提供比尿素更好的透析充分性指数。
更新日期:2020-01-04
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