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 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.
Department of Paediatrics, Division of Nephrology, Children's Hospital, London Health Science Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, Canada, N6A 5W9, guido.filler@lhsc.on.ca.
Guido
G
Filler
Sarah
S
Felder
D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects*; D017582:Renal Replacement Therapy / Q000379:methods; D014131:Trace Elements / Q000378:metabolism*
D014131:Trace Elements