University of British Columbia (Pediatrics), Vancouver, British Columbia, Canada.
British Columbia Children's Hospital Research Institute (Analytical Core for Metabolomics and Nutrition), Vancouver, British Columbia, Canada.
Pediatr Nephrol. 2021 Apr;36(4):987-993. doi: 10.1007/s00467-020-04797-9. Epub 2020 Oct 16.
Oxythiamine is a uremic toxin that acts as an antimetabolite to thiamine and has been associated with cases of Shoshin beriberi syndrome in adults. We sought to identify whether surgical stress and ischemia/reperfusion injury may precipitate functional thiamine deficiency in children peritransplant.
We retrospectively analyzed a cohort of pediatric kidney transplant recipients. Oxythiamine levels were measured in pre-transplant serum samples by mass spectrometry and tested for association with severity of lactic acidosis in the first 24 h post-transplant. Secondary outcomes included association with hyperglycemia and indicators of dialysis adequacy (DA).
Forty-seven patients were included in the analysis. Median oxythiamine levels differed by modality, measuring 0.67 nM (IQR 0.31, 0.74), 0.34 nM (IQR 0.28, 0.56), and 0.25 nM (IQR 0.17, 0.38) for peritoneal dialysis (PD), hemodialysis (HD), and no dialysis, respectively (p = 0.05). Oxythiamine was associated with 24-h lactate levels (r = 0.38, p = 0.02) and negatively associated with DA (r = - 0.44, p = 0.02). Median oxythiamine levels were higher in patients with poor DA (0.92 nM (IQR 0.51, 1.01) vs. 0.40 nM (IQR 0.24, 0.51), p < 0.01). Sensitivity analysis showed absence of residual association of oxythiamine with 24-h lactate or dialysis modality, but remained significant for DA (p = 0.03). One patient manifested Shoshin beriberi syndrome (oxythiamine 2.03 nM).
Oxythiamine levels are associated with DA at transplant. Patients on PD with no residual kidney function and low DA manifest the highest oxythiamine levels and may be at an increased risk for developing acute Shoshin beriberi syndrome in the early post-transplant period.
氧硫胺是一种尿毒症毒素，作为硫胺素的抗代谢物，与成人中的 Shoshin 脚气综合征病例有关。我们试图确定围移植期手术应激和缺血/再灌注损伤是否会导致儿童出现功能性硫胺素缺乏。
我们回顾性分析了一组儿科肾移植受者。通过质谱法测量移植前血清样本中的氧硫胺水平，并检测其与移植后 24 小时内乳酸酸中毒严重程度的关系。次要结局包括与高血糖和透析充分性（DA）指标的关系。
47 例患者纳入分析。中位数氧硫胺水平因方式而异，腹膜透析（PD）、血液透析（HD）和无透析分别为 0.67 nM（IQR 0.31，0.74）、0.34 nM（IQR 0.28，0.56）和 0.25 nM（IQR 0.17，0.38）（p = 0.05）。氧硫胺与 24 小时乳酸水平相关（r = 0.38，p = 0.02），与 DA 呈负相关（r = -0.44，p = 0.02）。DA 较差的患者中位氧硫胺水平较高（0.92 nM（IQR 0.51，1.01）vs. 0.40 nM（IQR 0.24，0.51），p < 0.01）。敏感性分析显示，氧硫胺与 24 小时乳酸或透析方式之间不存在残留关联，但与 DA 仍有显著关联（p = 0.03）。1 例患者表现出 Shoshin 脚气综合征（氧硫胺 2.03 nM）。
氧硫胺水平与移植时的 DA 相关。PD 患者无残余肾功能且 DA 较低，表现出最高的氧硫胺水平，并且在移植后早期发生急性 Shoshin 脚气综合征的风险可能增加。
