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Reduced protein bound uraemic toxins in vegetarian kidney failure patients treated by haemodiafiltration

机译：血液透析滤过治疗可降低素食肾衰竭患者蛋白结合的尿毒症毒素

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Introduction Indoxyl sulfate (IS) and p cresyl sulfate (PCS) are protein bound toxins which accumulate with chronic kidney disease. Haemodiafiltration (HDF) increases middle molecule clearances and has been suggested to increase IS and PCS clearance. We therefore wished to establish whether higher convective clearances with HDF would reduce IS and PCS concentrations. Methods We measured total plasma IS and PCS in a cohort of 138 CKD5d patients treated by On-line HDF (Ol-HDF), by high pressure liquid chromatography. Findings Mean patient age was 64.66 16.5 years, 60.1% male, 57.3% diabetic, median dialysis vintage 25.9 months (12.4–62.0). The mean ICS concentration was 79.8656.4 umol/L and PCS 140.36101.8 umol/L. On multivariate analysis, IS was associated with serum albumin (b 4.31,P<0.001), and negatively with residual renal function (b-4.1,P50.02) and vegetarian diet(b-28.3, P50.048) and PCS negatively with log C reactive protein (b-75.8, P<0.001) and vegetarian diet (b-109, P50.001). Vegetarian patients had lower IS and PCS levels (median 41.5 (24.2–71.9) vs. 78.1 (49.5–107.5) and PCS (41.6 (14.2–178.3) vs. 127.3 (77.4–205.6) mmol/L, respectively, P<0.05. Vegetarian patients had lower preOl-HDF serum urea, and phosphate (13.8 63.8 vs. 18.465.2 mmol/L, and 1.3360.21 vs. 1.5860.45 mmol/L), and estimated urea nitrogen intake (1.2560.28 vs. 1.6260.5 g/kg/day), respectively, all P<0.05. Discussion Plasma IS and PCS concentrations were not lower with Ol-HDF compared to previous studies in haemodialysis patients. However those eating a vegetarian diet had reduced IS and PCS concentrations. Although this could be due to differences in dietary protein intake, a vegetarian diet may also potentially reduce IS and PCS production by the intestinal microbiome.
机译：简介硫酸吲哚酚（IS）和对甲酚硫酸酯（PCS）是与蛋白质结合的毒素，会随着慢性肾脏疾病而累积。血液透析滤过（HDF）可增加中间分子的清除率，并已建议增加IS和PCS清除率。因此，我们希望确定HDF的较高对流间隙是否会降低IS和PCS浓度。方法我们通过高压液相色谱法对在线HDF（Ol-HDF）治疗的138例CKD5d患者的总血浆IS和PCS进行了测量。结果平均患者年龄为64.66 16.5岁，男性60.1％，糖尿病57.3％，中位透析期25.9个月（12.4-62.0）。 ICS的平均浓度为79.8656.4 umol / L，PCS为140.36101.8 umol / L。在多变量分析中，IS与血清白蛋白（b 4.31，P <0.001）相关，与残余肾功能（b-4.1，P50.02）和素食（b-28.3，P50.048）和PCS呈负相关。 log C反应蛋白（b-75.8，P <0.001）和素食（b-109，P50.001）。素食患者的IS和PCS水平较低（中位数41.5（24.2–71.9）vs. 78.1（49.5–107.5）和PCS（41.6（14.2–178.3）vs. 127.3（77.4-205.6）mmol / L），P <0.05素食患者的preOl-HDF血清尿素和磷酸盐含量较低（分别为13.8 63.8 vs. 18.465.2 mmol / L和1.3360.21 vs. 1.5860.45 mmol / L），并且估计的尿素氮摄入量（1.2560.28vs。 （分别为1.6260.5 g / kg / day），所有P <0.05。讨论与以往的血液透析患者相比，Ol-HDF的血浆IS和PCS浓度没有降低，但是吃素食的人IS和PCS浓度降低尽管这可能是由于饮食中蛋白质摄入量的差异，但素食也可能会减少肠道微生物组产生IS和PCS的可能性。

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