SAT-241 ERYTHROCYTE GLUTATHIONE TRANSFERASE: A PROMISING MARKER FOR HEMODIALYSIS ADEQUACY

Abstract

Identification of new clinical indicators for ideal dialysis is an interest. Erythrocyte glutathione transferase (e-GST) is non-dialyzable enzyme compartmentalized in the red cells. It may act as ligandins by binding and sequestering a variety of small or large toxic compounds and peptides. The aim of the study was to verify whether e-GST is able to assess hemodialysis adequacy among different treatment modalities, as a complementary to the Kt/V urea parameter. This cross sectional study included 20 ESRD patients on conventional HD, 20 ESRD patients on HDF (for at least 6 month), and 20 healthy subjects as control. Patients with Hyperbilirubinemia and Chronic liver disease were excluded. Serum e-GST was measured for all patients and for control group. Kt/V and URR were calculated for all patients. Serum e-GST can predict inadequate dialysis at cut off value >14 ng/ml with area under curve (AUC) 0.871, sensitivity 95%, specificity 60%, PPV 70.4% and NPV 92.3%. The marker e-Gst was significantly high in patients on conventional HD and HDF (mean ±SD 18.35±5.61, 15.20±4.40) respectively compared with control subjects (mean ±SD 2.80±1.36) P value <0.0001. Post hoc analysis showed significant difference between control and both conventional and HDF patients (P <0.0001, 0.0001) respectively while no significant differences between conventional HD and HDF patients P value (0.061) were observed. Patients was redistributed according to kt/v. The prevalence of e-GST level in patients with inadequate dialysis (Kt/V ≤ 1.3) was 95 %( 19 patients) while it was 40% (8 patients) in patients with Kt/V > 1.3 with P-value (0.001). The patients who have elevated e-GST are at higher risk for inadequate dialysis (odds ratio: 28.5). Patients with kt/v ≤1.3 have significantly lower URR and higher e-Gst (mean ±SD 62.07±6.28, 20.05±4.35) respectively compared with kt/v >1.3 (mean ±SD 75.78±4.36, 13.5±3.82) respectively (p value 0.0001, 0.0001) respectively. In conventional HD and HDF e-Gst was negatively correlated with kt/v and URR (kt/v r=-0.746, -0.790 P<0.0001, 0.0001) respectively, (URR -0.714,-0.771 P<0.0001, 0.0001) respectively. Erythrocyte glutathione transferase appears to be a sensitive marker for assessment hemodialysis adequacy among different treatment modalities. In addition, it has the advantage of being easily measured and not requiring complex calculations for interpretation as compared to other methods such as URR and Kt/V.