Kidney Week

Abstract: TH-PO238

Serum (1-3)-β-D-glucan Levels after Oral β-D-glucan Load in Controls and People with ESKD on High-Flux Hemodialysis (HD) and Hemodialysis Filtration (HDF)

Session Information

• Hemodialysis, Hemodiafiltration, and Frequent Dialysis
  October 24, 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

Oscar Swift, MBBS

• Finkelman, Malcolm A., Associates Of Cape Cod Inc, East Falmouth, Massachusetts, United States

Malcolm A. Finkelman, PhD

• Zhang, Yonglong, Associates Of Cape Cod Inc, East Falmouth, Massachusetts, United States

Yonglong Zhang, MD, PhD

• Sridharan, Sivakumar, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, United Kingdom

Sivakumar Sridharan, MBBS, PhD

• Vilar, Enric, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, United Kingdom

Enric Vilar, MA, MBChB, PhD

• Farrington, Ken, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, United Kingdom

Ken Farrington, MD

Background

(1-3)-β-D glucan (BDG) is elevated in ESKD in the absence of active infection. Elevated levels may reflect increased gut permeability.

This study aimed to:

1. Establish differences in serum levels of BDG in controls and individuals with ESKD following an oral BDG load.

2. Evaluate relationships between fasting pre- and post-HD BDG levels and high-flux HD and HDF in a larger cohort.

Methods

1. 20 adults with ESKD receiving high-flux HD (n=5) or HDF (n=15) with chronic inflammation (baseline hs-CRP ≥5mg/L) and 20 controls were recruited. Following a BDG oral load, serial serum BDG levels were taken. One participant (HDF subgroup) was excluded post-hoc due to acute diverticulitis soon after study participation.

2. Fasting serum BDG samples from 443 outpatients receiving high flux-HD (n=156) or HDF (n=287) were obtained pre- and post-HD.

Results

1. Serum BDG was higher at all timepoints in the ESKD group compared to controls. There were no differences in change from baseline BDG in either group post-BDG load (Figure 1a), but levels in the HDF subgroup were higher (Figure 1b).

2. Pre-HD fasting BDG levels were similar in high flux-HD and HDF groups (57(42) vs 64(45)pg/ml; p = 0.057). Weight, hs-CRP, and presence of diabetes and liver disease were independent predictors of pre-HD BDG. BDG levels (high flux-HD group) were similar pre- and post-HD (57(42) vs 53(53); p=0.132). In contrast, BDG levels (HDF group) were higher post-HD (64(45) vs 76.6(51)pg/ml; p<0.001).

Conclusion

BDG levels were higher at baseline in ESKD compared to controls. Following an oral BDG load, there was a significant increase in BDG levels from baseline in the HDF subgroup but not high-flux HD.

Higher BDG levels were also observed post-HD in patients receiving HDF in the absence of an oral BDG load. This finding is unexpected and warrants further investigation as HDF is theoretically associated with greater haemodynamic stability and should protect against gut permeability and systemic translocation of BDG-rich material.

Funding

• Other NIH Support – Associates of Cape Cod provided assays for BDG measurements gratis