Abstract: SA-PO394
Hepatic Function Is Impaired in Inflamed Haemodialysis Patients
Session Information
- Hemodialysis and Frequent Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Swift, Oscar, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, United Kingdom
- Dasari, Bobby VM, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
- Finkelman, Malcolm A., Associates Of Cape Cod Inc, East Falmouth, Massachusetts, United States
- Zhang, Yonglong, Associates Of Cape Cod Inc, East Falmouth, Massachusetts, United States
- Sridharan, Sivakumar, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, United Kingdom
- Vilar, Enric, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, United Kingdom
- Farrington, Ken, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, United Kingdom
Background
Impaired hepatic function may drive inflammation in ESKD via reduced gut-derived toxin removal. (1-3)-β-D glucan (BDG), found in cell walls of bacteria and fungi, is often raised in ESKD and may reflect systemic translocation of gut material.
This study evaluated hepatic function in inflamed and non-inflamed individuals on haemodialysis (HD). BDG was used as a surrogate marker of gut permeability.
Methods
25 inflamed adults with ESKD (baseline hs-CRP >5mg/L) and 25 non-inflamed adults with ESKD (hs-CRP ≤5mg/L) were recruited from four UK outpatient HD units.
Dynamic hepatic function was assessed by indocyanine green (ICG) clearance. ICG levels were measured transcutaneously to calculate plasma disappearance rate (ICG-PDR) and retention at 15 minutes (ICG-R15min). Fibroscan imaging assessed hepatic steatosis and fibrosis.
Results
ICG-PDR and ICG-R15min were, respectively, reduced and elevated, in inflamed individuals. Hepatic steatosis and fibrosis, and pre-HD BDG were similar between groups (Table 1). Post-HD BDG was higher in the inflamed group (Table 1), and in those with hepatic impairment (Figure 1).
Conclusion
Hepatic function is impaired in inflamed individuals receiving HD. Impaired hepatic function associates with elevated BDG post-HD, suggesting that impaired hepatic removal of gut-derived toxins may propagate chronic inflammation in ESKD.
Comparison of hepatic function and BDG levels in non-inflamed and inflamed individuals receiving HD
| Non-inflamed (n=25) | Inflamed (n=25) | p-value | |
| ICG-PDR (%/min)* | 23.8(14.4) | 19.4(8.7) | 0.02 |
| ICG-R15min (%)* | 2.9(5.0) | 5.4(7.6) | 0.02 |
| Liver Stiffness Measurement (kPa)† | 4.8(2.1) | 4.2(32.7) | 0.69 |
| Controlled Attenuation Parametography (dB/m)† | 249±69 | 257±63 | 0.69 |
| Pre-dialysis BDG (pg/ml) | 49(12) | 58(38) | 0.13 |
| Post-dialysis BDG (pg/ml) | 58(27) | 81(48) | <0.001 |
Continuous variables presented as mean±SD or median(IQR) according to distribution *Data for 24 non-inflamed and 23 inflamed participants †Data for 24 non-inflamed and 25 inflamed participants
Funding
- Other NIH Support – Associates of Cape Cod provided assays for BDG measurement gratis