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Better Understanding Dialysis in Children

Friday, January 11, 2013 - Campus News - Contact Theresa Green, (405) 833-9824

It's not just adults who endure dialysis. Children do also. Now, a new study by researchers at the University of Oklahoma Health Sciences Center aims to better understand the effectiveness of dialysis in pediatric patients.

Dialysis is used in patients experiencing kidney failure. It does what the kidneys are no longer able to do sufficiently, removing toxins and excess water from the blood.  

The OU study is the first to examine what happens to a particular molecule, Cystatin C, during dialysis in children.

"Cystatin C is a molecule that recently has been suggested as a better molecule for measuring how well kidneys work," said Dr. Olivera Marsenic Couloures, a pediatric nephrologist with OU Children's Physicians. "We hypothesized that if Cystatin C is so good at measuring kidney function, then it is possibly also good at measuring artificial kidney function, i.e. dialysis."

Couloures and fellow researchers examined Cystatin C levels in pediatric patients undergoing dialysis.

"Currently, dialysis regimens provided to children are less than optimal," Couloures said. "Investigations like this may prompt us to realize that improved treatments are necessary for better long-term outcomes in children on dialysis."

The study followed seven children through 21 dialysis sessions. Doctors took the children's blood samples during and between dialysis treatments over a seven-day period and tested the blood samples for Cystatin C and two other molecules. Researchers wanted to see how well Cystatin C is cleared from the body, how much Cystatin C levels change between treatments and how the results compare to molecules currently used to measure the quality of dialysis treatments.

"We found that Cystatin C is very elevated in children on dialysis and that it is not removed by dialysis treatments that are currently the routine practice. This would suggest that other molecules similar in size to Cystatin C are not removed by dialysis either," Couloures said. 

In fact, researchers discovered that not even a small amount of Cystatin C is removed by routine dialysis in children.

"This means that we need to provide treatments with different equipment to be able to remove bigger molecules of a size similar to Cystatin C," says Couloures.

Surprisingly, researchers discovered that the larger the pediatric patient, the higher the level of Cystatin C. That finding was contrary to the prevailing belief that Cystatin C levels are not related to the patient's size.

Dr. Couloures hopes the study alerts the medical community to the fact that children with kidney failure need intensified dialysis regimens on a routine basis.

"If these [intensified] treatments become routine," she said, "then we suggest that Cystatin C levels be used to measure the quality of these treatments."

Since the study examined only a small number of patients, Dr. Couloures and her fellow OUHSC researchers next hope to have their findings confirmed in a larger clinical study.  

Future research may also address the issues of whether elevated levels of Cystatin C cause cardiovascular disease and whether organs other than the kidney break down or excrete Cystatin C from the body.

The Cystatin C study is published in the online edition of Pediatric Nephrology, a publication of the International Pediatric Nephrology Association.

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