Trace elements in dialysis

In end-stage chronic kidney disease (CKD), pediatric nephrologists must consider the homeostasis of the multiple water-soluble ions that are influenced by renal replacement therapy (RRT). While certain ions such as potassium and calcium are closely monitored, little is known about the handling of tr...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2014-08, Vol.29 (8), p.1329-1335
Main Authors: Filler, Guido, Felder, Sarah
Format: Article
Language:English
Subjects:
Aluminum
Anemia
Cadmium
Care and treatment
Chronic kidney failure
Copper
Dermatitis
Development and progression
Dialysate
Dialysis
Educational Review
Electrons
Health aspects
Hemodialysis
Hospitals
Humans
Kidney diseases
Kidney Failure, Chronic - metabolism
Kidney Failure, Chronic - therapy
Lead content
Medicine
Medicine & Public Health
Nephrology
Patient outcomes
Pediatrics
Peritoneal dialysis
Plasma
Potassium
Renal Dialysis - adverse effects
Renal replacement therapy
Renal Replacement Therapy - methods
Selenium
Toxicity
Trace elements
Trace Elements - metabolism
Urology
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Summary:In end-stage chronic kidney disease (CKD), pediatric nephrologists must consider the homeostasis of the multiple water-soluble ions that are influenced by renal replacement therapy (RRT). While certain ions such as potassium and calcium are closely monitored, little is known about the handling of trace elements in pediatric dialysis. RRT may lead to accumulation of toxic trace elements, either due to insufficient elimination or due to contamination, or to excessive removal of essential trace elements. However, trace elements are not routinely monitored in dialysis patients and no mechanism for these deficits or toxicities has been established. This review summarizes the handling of trace elements, with particular attention to pediatric data. The best data describe lead and indicate that there is a higher prevalence of elevated lead (Pb, atomic number 82) levels in children on RRT when compared to adults. Lead is particularly toxic in neurodevelopment and lead levels should therefore be monitored. Monitoring of zinc (Zn, atomic number 30) and selenium (Se, atomic number 34) may be indicated in the monitoring of all pediatric dialysis patients to reduce morbidity from deficiency. Prospective studies evaluating the impact of abnormal trace elements and the possible therapeutic value of intervention are required.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-013-2585-6