Plasma pseudouridine levels reflect body size in children on hemodialysis.
Plasma pseudouridine levels reflect body size in children on hemodialysis.
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血浆假尿苷水平反映了血液透析儿童的体型。
DOI：
10.1007/s00467-019-04369-6
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Meyer,TimothyW
中科院分区：
文献类型：
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作者：
O'Brien,FrankJ;Sirich,TammyL;Taussig,Abigail;Fung,Enrica;Ganesan,LakshmiL;Plummer,NatalieS;Brakeman,Paul;Sutherland,ScottM;Meyer,TimothyW
儿童和成人的透析是为了达到目标spKt/Vurea，其中vureis指尿素的分布体积。然而，废物溶质的产生可能与体表面积（BSA）的关系比vurea更密切，后者与体重成比例上升。因此，当以spKt/ vuase为靶标时，体型较小的患者的血浆废溶质水平可能更高，因为他们的BSA相对于体重更高。这项研究测量了假尿嘧啶（PU）的水平，PU是一种新的标记溶质，其产量与BSA密切相关，以测试透析处方是否会导致较小儿童的血浆PU水平升高。方法对20例周中血液透析患儿进行血浆和透析液中spu和尿素氮（ureaN）的测定，BSA范围为0.65 ~ 1.87m2。采用数学模型估计溶质生成速率和平均等离子体溶质水平。结果PU的透析清除率（Kd）与尿素的透析清除率成正比（平均KdPU/KdUreaN0.69±0.13,r20.84,p< 0.001）。PU产量与BSA成正比（r20.57, p < 0.001）。预处理血浆PU水平在小个子儿童中显著升高（r20.20,p= 0.051），而预处理血浆尿素水平不随大小变化。结论根据尿素动力学开具透析处方可能使儿童尿毒症溶质水平升高。测量与BSA成比例的溶质可能比测量尿素提供更好的透析充分性指标。
BackgroundDialysis in children as well as adults is prescribed to achieve a target spKt/Vurea, where Vureais the volume of distribution of urea. Waste solute production may however be more closely correlated with body surface area (BSA) than Vureawhich rises in proportion with body weight. Plasma levels of waste solutes may thus be higher in smaller patients when targeting spKt/Vureasince 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/Vurearesults in higher plasma levels of PU in smaller children.MethodsPU 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.ResultsThe dialytic clearance (Kd) of PU was proportional to that of ureaN (average KdPU/KdUreaN0.69 ± 0.13, r20.84,p< 0.001). Production of PU rose in proportion with BSA (r20.57, p < 0.001). The pretreatment plasma level of PU was significantly higher in smaller children (r20.20,p= 0.051) while the pretreatment level of ureaN did not vary with size.ConclusionsPrescribing 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.