Dr Aruni Malaweera1, Dr Louis Huang1, Professor Lawrence McMahon1
1Eastern Health, Box Hill, Australia
Biography:
Aruni Malaweera is a PhD fellow at Eastern Health, Victoria
Aim:
To understand the correlation between uraemic toxins, fibre intake and patient-focused outcomes in dialysis and kidney transplant patients
Background:
Despite removal of uraemic toxins including urea and creatinine, dialysis patients continue to experience high morbidity and mortality. Recent evidence suggests strong associations between protein-bound uraemic toxins (PBTs) with poorer patient outcomes and symptom burden. Reducing the generation of PBTs by increased dietary fibre may be an alternate approach to better patient outcomes.
Method:
This is a cross-sectional study of haemodialysis (HD), peritoneal dialysis (PD) and kidney transplant patients to determine the associations between uraemic toxins (urea, creatinine, p-cresyl sulfate [PCS] and indoxyl sulfate [IS]), fibre intake and patient-focused outcomes (symptom burden using IPOS-renal and EQ5D5L, physical ability using timed up-and-go (TUG) and hand-grip strength).
Results:
Ninety participants completed the study (n=30 in each group). There was a strong correlation between serum PCS, IS, urea and creatinine with the IPOS-renal score, where higher toxin levels were associated with higher symptom burden; their significance remained after accounting for age and co-morbidities by regression analysis (p<0.05 for all toxins). Higher toxin levels were also associated with lower grip strength and longer TUG time (p<0.05). There was a strong negative correlation between fibre intake and toxin levels, especially for serum PCS (r=-0.358, p<0.001). Lower fibre intake was also associated with a higher symptom burden measured by the IPOS-renal (p<0.05). Transplant patients had consistently better physical ability and reduced symptom burden compared to dialysis patients.
Conclusion:
Uraemic toxins, either water-soluble or protein-bound, were associated with symptom burden and lower physical ability. Fibre intake also influenced this relationship, and may be a potential therapeutic intervention to improve dialysis patient outcomes.
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