Abstract: SA-PO1009
Non-GFR Determinants of Endogenous Filtration Markers in Dialysis Patients
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Michels, Wieneke, Leiden University Medical Center, Leiden, Netherlands
- Hwang, Seungyoung, American Psychiatric Association, Washington, District of Columbia, United States
- Krediet, Raymond T., Academic Medical Center, Amsterdam, Netherlands
- Dekker, Friedo W., Leiden University Medical Center, Leiden, Netherlands
- Shafi, Tariq, University of Mississippi Medical Center, Jackson, Mississippi, United States
Background
When kidney function declines, measurement of residual kidney function (RKF) becomes challenging, while the importance of precise measurement rises. We sought to understand the non-GFR determinants of endogenous filtration markers (Beta-2-microglobulin (B2M), Beta-Trace Protein (BTP), and cystatin C) in dialysis patients.
Methods
We measured GFR (mGFR; average of urinary urea and creatinine clearance) and estimated GFR (eGFR) from endogenous markers in patients from the Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD) cohort. We used stacked generalized estimating equation (GEE) models to estimated associations of several factors with eGFR, including mGFR.
Results
1107 patients were eligible for inclusion, of whom 224 without RKF. Mean age was 61 (± 15) years, and mean mGFR was 4,4 (± 32,1) ml/min/1.73m2 . In those with RKF. BTM, BTP and Cystatin C were all associated with age. Only BTP was associated with race. All associations became smaller after accounting for mGFR. Compared to creatinine, the effect of age was significantly smaller for B2M, and the effect of sex was significantly smaller for B2M and Cystatin C. After adjustment for age, sex and race associations dialysis modality was significantly less strong associated with BTP than with mGFR. Additional adjustment for mGFR resulted in a smaller associations for diabetes with cystatine C when compared to creatinine. However, diabetes was stronger associated with BTP than creatinine.
Conclusion
In dialysis patients, BTP, B2M, and cystatin C were mainly influenced by mGFR, but additionally by age sex and race. Furthermore, diabetes and dialysis modality also influenced these results. Use of these makers for GFR estimation should account for these influences.
Funding
- Government Support - Non-U.S.