Show simple item record

dc.contributor.authorVilar, Enric
dc.contributor.authorBoltiador, Capella
dc.contributor.authorWong, Jonathan
dc.contributor.authorViljoen, Adie
dc.contributor.authorMachado, Ashwini
dc.contributor.authorUthayakumar, Arani
dc.contributor.authorFarrington, Kenneth
dc.date.accessioned2017-07-05T15:57:58Z
dc.date.available2017-07-05T15:57:58Z
dc.date.issued2015-12-02
dc.identifier.citationVilar , E , Boltiador , C , Wong , J , Viljoen , A , Machado , A , Uthayakumar , A & Farrington , K 2015 , ' Plasma Levels of Middle Molecules to Estimate Residual Kidney Function in Haemodialysis without Urine Collection ' , PLoS ONE , vol. 10 , no. 12 , e0143813 . https://doi.org/10.1371/journal.pone.0143813
dc.identifier.issn1932-6203
dc.identifier.otherPURE: 10593931
dc.identifier.otherPURE UUID: aa6a6d85-b255-47cc-8ddd-286a1ce77954
dc.identifier.otherPubMed: 26629900
dc.identifier.otherScopus: 84955464727
dc.identifier.urihttp://hdl.handle.net/2299/18786
dc.description© 2015 Vilar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, (http://creativecommons.org/Licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
dc.description.abstractBACKGROUND: Residual Kidney Function (RKF) is associated with survival benefits in haemodialysis (HD) but is difficult to measure without urine collection. Middle molecules such as Cystatin C and β2-microglobulin accumulate in renal disease and plasma levels have been used to estimate kidney function early in this condition. We investigated their use to estimate RKF in patients on HD. DESIGN: Cystatin C, β2-microglobulin, urea and creatinine levels were studied in patients on incremental high-flux HD or hemodiafiltration(HDF). Over sequential HD sessions, blood was sampled pre- and post-session 1 and pre-session 2, for estimation of these parameters. Urine was collected during the whole interdialytic interval, for estimation of residual GFR (GFRResidual = mean of urea and creatinine clearance). The relationships of plasma Cystatin C and β2-microglobulin levels to GFRResidual and urea clearance were determined. RESULTS: Of the 341 patients studied, 64% had urine output>100 ml/day, 32.6% were on high-flux HD and 67.4% on HDF. Parameters most closely correlated with GFRResidual were 1/β2-micoglobulin (r2 0.67) and 1/Cystatin C (r2 0.50). Both these relationships were weaker at low GFRResidual. The best regression model for GFRResidual, explaining 67% of the variation, was: GFRResidual = 160.3 · (1/β2m) - 4.2. Where β2m is the pre-dialysis β2 microglobulin concentration (mg/L). This model was validated in a separate cohort of 50 patients using Bland-Altman analysis. Areas under the curve in Receiver Operating Characteristic analysis aimed at identifying subjects with urea clearance≥2 ml/min/1.73 m2 was 0.91 for β2-microglobulin and 0.86 for Cystatin C. A plasma β2-microglobulin cut-off of ≤19.2 mg/L allowed identification of patients with urea clearance ≥2 ml/min/1.73 m2 with 90% specificity and 65% sensitivity. CONCLUSION: Plasma pre-dialysis β2-microglobulin levels can provide estimates of RKF which may have clinical utility and appear superior to cystatin C. Use of cut-off levels to identify patients with RKF may provide a simple way to individualise dialysis dose based on RKF.en
dc.language.isoeng
dc.relation.ispartofPLoS ONE
dc.subjectCystatin C
dc.subjectFemale
dc.subjectHumans
dc.subjectKidney
dc.subjectKidney Diseases
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectRenal Dialysis
dc.subjectSurvival Analysis
dc.subjectbeta 2-Microglobulin
dc.titlePlasma Levels of Middle Molecules to Estimate Residual Kidney Function in Haemodialysis without Urine Collectionen
dc.contributor.institutionSchool of Life and Medical Sciences
dc.contributor.institutionHealth & Human Sciences Research Institute
dc.contributor.institutionCentre for Postgraduate Medicine
dc.contributor.institutionDepartment of Pharmacy, Pharmacology and Postgraduate Medicine
dc.contributor.institutionPostgraduate Medicine
dc.contributor.institutionBasic and Clinical Science Unit
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.description.statusPeer reviewed
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.1371/journal.pone.0143813
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record