Abstract
ObjectiveCurrent treatment options for patients with stage 5 chronic kidney disease before dialysis (predialysis CKD-5) are determined by individual circumstances, economic factors, and the doctor’s advice. This study aimed to explore the plasma metabolic traits of patients with predialysis CKD-5 compared with maintenance hemodialysis (HD) and peritoneal dialysis (PD) patients, to learn more about the impact of the dialysis process on the blood environment.MethodsOur study enrolled 31 predialysis CKD-5 patients, 31 HD patients, and 30 PD patients. Metabolite profiling was performed using a targeted metabolomics platform by applying an ultra-high-performance liquid chromatography-tandem mass spectrometry method, and the subsequent comparisons among all three groups were made to explore metabolic alterations.ResultsCysteine metabolism was significantly altered between predialysis CKD-5 patients and both groups of dialysis patients. A disturbance in purine metabolism was the most extensively changed pathway identified between the HD and PD groups. A total of 20 discriminating metabolites with large fluctuations in plasma concentrations were screened from the group comparisons, including 2-keto-D-gluconic acid, kynurenic acid, s-adenosylhomocysteine, L-glutamine, adenosine, and nicotinamide.ConclusionOur study provided a comprehensive metabolomics evaluation among predialysis CKD-5, HD, and PD patients, which described the disturbance of metabolic pathways, discriminating metabolites and their possible biological significances. The identification of specific metabolites related to dialysis therapy might provide insights for the management of advanced CKD stages and inform shared decision-making.
Highlights
Chronic kidney disease (CKD) has received significant attention and has become a public health problem over recent decades
A cross-sectional cohort study of 61 stable uremia patients treated with dialysis for at least 6 months (HD, 31 patients; peritoneal dialysis (PD), patients) and predialysis CKD-5 patients without any history of dialysis therapy were enrolled in our study at Changzheng hospital (Shanghai, China)
No significant differences in age and body mass index were identified among the patient groups
Summary
Chronic kidney disease (CKD) has received significant attention and has become a public health problem over recent decades. To maintain normal metabolic homeostasis, patients in stage 5 CKD are often required to undergo dialysis or prepare for transplantation programs. Kidney transplantation is the preferred treatment method for patients with end-stage renal disease (ESRD), most patients are placed on dialysis while awaiting transplantation because of limited available donor kidneys (Fenton et al, 1997). Similar outcomes have been reported for PD and HD in several recent studies, and the treatment options available for patients with stage 5 CKD before dialysis (predialysis CKD-5 patients) are primarily determined by individual circumstances, economic factors, and the doctor’s advice, HD remains the most common initial modality for pediatric patients (Gilmore, 2006; Saran et al, 2015). Studies comparing survival between these modalities have yielded conflicting results (Wang et al, 2020)
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