Abstract
Diagnosis of pheochromocytomas and paragangliomas in patients receiving hemodialysis is troublesome. The aim of the study was to establish optimal conditions for blood sampling for mass spectrometric measurements of normetanephrine, metanephrine and 3-methoxytyramine in patients on hemodialysis and specific reference intervals for plasma metanephrines under the most optimal sampling conditions. Blood was sampled before and near the end of dialysis, including different sampling sites in 170 patients on hemodialysis. Plasma normetanephrine concentrations were lower (P < 0.0001) and metanephrine concentrations higher (P < 0.0001) in shunt than in venous blood, with no differences for 3-methoxytyramine. Normetanephrine, metanephrine and 3-methoxytyramine concentrations in shunt and venous blood were lower (P < 0.0001) near the end than before hemodialysis. Upper cut-offs for normetanephrine were 34% lower when the blood was drawn from the shunt and near the end of hemodialysis compared to blood drawn before hemodialysis. This study establishes optimal sampling conditions using blood from the dialysis shunt near the end of hemodialysis with optimal reference intervals for plasma metanephrines for the diagnosis of pheochromocytomas/paragangliomas among patients on hemodialysis.
Highlights
Number (n) Female (%) Age BMI Hypertension Systolic blood pressure Diastolic blood pressure Hypertensive patients using antihypertensives (%) Patients on beta-blocker (%) Patients on ARBs/ACEi (%) Diabetes type II (%) ICTc treatment (%) Causes of HD Diabetic and hypertensive kidney disease (%) Chronic glomerulonephritis (%) Polycystic kidney disease (%) Systemic diseased (%) Chronic pyelonephritis (%) Othere (%) Hematocrit % GFR Creatinine Urea Dialysis flow Plasma flow Clearance of metanephrines of HD on the assessment of plasma metanephrines has not been studied to date
The main goal of the study was to establish optimal conditions for blood sampling for measurements of plasma free metanephrines and 3-methoxytyramine in patients on HD
The present study establishes that measurements of plasma metanephrines in patients receiving HD are most appropriate using blood drawn from shunt at a time near the end of dialysis (Box 1)
Summary
Number (n) Female (%) Age (years) BMI (kg/m2) Hypertension Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Hypertensive patients using antihypertensives (%) Patients on beta-blocker (%) Patients on ARBs/ACEi (%) Diabetes type II (%) ICTc treatment (%) Causes of HD Diabetic and hypertensive kidney disease (%) Chronic glomerulonephritis (%) Polycystic kidney disease (%) Systemic diseased (%) Chronic pyelonephritis (%) Othere (%) Hematocrit % GFR (mL/min) Creatinine (μmoL/L) Urea (mmoL/L) Dialysis flow (mL/min) Plasma flow (mL/min) Clearance of metanephrines (mL/min) of HD on the assessment of plasma metanephrines has not been studied to date It is not yet clarified if modifications of blood sampling would improve the diagnostic performance of measurements of plasma metanephrines in patients receiving HD. The aim of the study was, to establish optimal procedures for blood sampling to determine plasma concentrations of free metanephrines and 3-methoxytyramine in patients receiving HD
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