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Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Am+J+Nephrol 2014 ; 39 (5): 376-82 Nephropedia Template TP
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Oxalate quantification in hemodialysate to assess dialysis adequacy for primary hyperoxaluria #MMPMID24776840
Am J Nephrol 2014[]; 39 (5): 376-82 PMID24776840show ga
Background: Patients with primary hyperoxaluria (PH) overproduce oxalate which is eliminated via the kidneys. If end stage kidney disease develops they are at high risk for systemic oxalosis, unless adequate oxalate is removed during hemodialysis to equal or exceed ongoing oxalate production. The purpose of this study was to validate a method to measure oxalate removal in this unique group of dialysis patients. Methods: Fourteen stable patients with a confirmed diagnosis of PH on hemodialysis were included in the study. Oxalate was measured serially in hemodialysate and plasma samples in order to calculate rates of oxalate removal. Hemodialysis regimens were adjusted according to a given patient's historical oxalate production, amount of oxalate removal at dialysis, residual renal clearance of oxalate, and plasma oxalate levels. Results: After a typical session of hemodialysis, plasma oxalate was reduced by 78.4±7.7%. Eight patients performed hemodialysis 6 times a week, two patients 5 times a week and three patients 3 times a week. Combined oxalate removal by hemodialysis and the kidneys was sufficient to match or exceed endogenous oxalate production. After a median period of 9 months, pre-dialysis plasma oxalate was significantly lower than initially (75.1±33.4 mmol/L vs. 54.8±46.6 mmol/L, P=0.02). Conclusion: This methodology can be used to individualize the dialysis prescription of PH patients to prevent oxalosis during the time they are maintained on hemodialysis, and to reduce risk of oxalate injury to a transplanted kidney.