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Estimation of residual renal function using beta‐trace protein: Impact of dialysis procedures

机译：使用β-痕量蛋白估计残留肾功能：透析程序的影响

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Abstract Beta‐trace protein (BTP), a low molecular weight protein of 23‐29?kDa, has been proposed as a promising biomarker to estimate residual renal function (RRF) in patients on maintenance hemodialysis (HD). Indeed, BTP is cleared by native kidney but not during conventional HD session. By contrast, the removal rate of BTP using convective processes (mainly hemodiafiltration [HDF]) and peritoneal dialysis (PD) has been little or not investigated. Therefore, an aim of this study was to evaluate the impact of dialysis procedures (high‐flux HD, on‐line post‐dilution HDF and PD) on BTP removal in comparison with beta‐2 microglobulin (B2M) and cystatin C (CYSC) removals after a single session. In addition, the ability of BTP to predict RRF in PD was assessed. This observational cross‐sectional study included a total of 82 stable chronic kidney disease patients, 53 patients were on maintenance dialysis (with n?=?26 in HD and n?=?27 in HDF) and 29 were on PD. Serum concentrations of BTP, B2M, and CYSC were measured (a) before and after a single dialysis session in HD and HDF anuric patients to calculate reduction percentages, (b) in serum, 24‐hour‐dialysate and 24‐hour‐urine in PD patients to compute total, peritoneal, and urinary clearance. RRF was estimated using four equations developed for dialysis patients without urine collection and compared to the mean of the urea and creatinine clearances in PD. The concentrations of the three studied molecules were significantly reduced ( P ??.001) after dialysis session with significantly higher reduction ratio using HDF compared to HD modality ( P ??.001): BTP 49.3% vs 17.5%; B2M 82.3% vs 69.7%; CYSC 77.4% vs 66% in HDF and HD, respectively. In non‐anuric PD patients, B2M and CYSC were partly removed by peritoneal clearance (72.3% and 57.6% for B2M and CYSC, respectively). By contrast, BTP removal by the peritoneum was negligible and a low bias for the BTP‐based equation to estimate RRF (?1.4?mL/min/1.73?m 2 ) was calculated. BTP is significantly removed by high‐flux HD or HDF, thereby compromising its use to estimate RRF. By contrast, BTP appears as a promising biomarker to estimate RRF in PD patients since it is not affected by peritoneal clearance, unlike B2M and CYSC, and it is well correlated to RRF.
机译：摘要β-痕量蛋白（BTP），23-29℃的低分子量蛋白是kda，作为有前途的生物标志物，以估算维持血液透析患者（HD）患者残留的肾功能（RRF）。实际上，BTP由母语肾脏清除，但在传统的高清会议期间没有清除。相比之下，使用对流方法的BTP去除率（主要是血液透析[HDF]）和腹膜透析（PD）几乎没有研究。因此，本研究的目的是评估透析程序（高通量HD，在线稀释HDF和PD）对BTP去除的影响，与β-2微球蛋白（B2M）和胱抑素C（CYSC）相比单个会话后删除。此外，评估了BTP预测PD中RRF的能力。这种观察横截面研究包括总共82例稳定的慢性肾病患者，53名患者在维持透析（HD中的N？= 26℃，N？=Δ27在HDF中）和29次。在HD和HDF抗阴碱患者中单透析会（A）之前和之后测量（a）血清BTP，B2M和CYSC，以计算血清，24小时透析液和24小时尿液中的减少百分比，（B） PD患者计算总，腹膜和泌尿情况。使用针对透析患者的四个方程估计RRF，没有尿液收集，与PD中尿素和肌酐间隙的平均值相比。与高清模态相比，使用HDF的减少比率显着更高的透析比（p≤001），在透析会的透析比率显着降低（p≤001）的浓度（p≤x≤001）。 B2M 82.3％与69.7％; CYSC分别为HDF和HD的77.4％vs 66％。在非抗阳性PD患者中，分别通过腹膜间隙部分除去B2M和CySC（分别为B2M和CYSC的72.3％和57.6％）。相比之下，突腹部的BTP除去可忽略不计，并计算基于BTP的方程的低偏差，以估计RRF（α1.4？ml / min / 1.73Δm2）。通过高通量HD或HDF显着消除BTP，从而损害其用于估计RRF的用途。相比之下，BTP表现为有希望的生物标志物来估计PD患者中的RRF，因为它不受腹膜间隙的影响，与B2M和CYSC不同，与RRF有很好的相关性。

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