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Abstract: PO1161

Accumulation in Hemodialysis Patients of Solutes Secreted by the Native Kidneys

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lee, Seolhyun, Stanford Medicine, Stanford, California, United States
  • Bolanos, Christian G., Stanford Medicine, Stanford, California, United States
  • Mair, Robert, Stanford Medicine, Stanford, California, United States
  • Plummer, Natalie, Stanford Medicine, Stanford, California, United States
  • Meyer, Timothy W., Stanford Medicine, Stanford, California, United States
  • Sirich, Tammy L., Stanford Medicine, Stanford, California, United States
Background

The native kidneys rapidly clear numerous solutes by tubular secretion, a function not replicated by hemodialysis (HD). We examined whether solutes which are normally cleared by secretion accumulate to high levels in the plasma when kidney function is replaced by HD.

Methods

Metabolomic analysis was performed on plasma ultrafiltrate (UF) and urine from 16 control subjects (NL) and on plasma UF from 36 HD patients using an established platform (Metabolon). The fractional excretion (FE) for each solute was calculated as its urine to UF ratio relative to that of creatinine. The extent of accumulation in HD patients was calculated as the ratio of the average UF peak area for each solute in HD relative to NL subjects (HD/NL). An FE > 2 was considered evidence of secretion and only solutes detected in samples from all 16 NL subjects and 36 HD patients were analyzed.

Results

26 solutes had FE greater than 2 (mean 4.1±2.7, range 2.0 to 14.2). HD/NL ratios were significantly higher for solutes with greater FE values as shown in the Figure (R2 0.45, p <0.001). HD/NL ratios varied however among individual solutes with similar FE values.

Conclusion

Uremic solutes that are rapidly cleared by the kidneys tend to accumulate to high levels in HD patients. Non-renal clearance and differences in generation rate and distribution volumes may result in variable HD/NL ratios for solutes with similar secretory clearances in the native kidney.

Funding

  • Veterans Affairs Support