Serum retinol, retinol-binding protein, and transthyretin in children receiving dialysis.

OBJECTIVE: We investigated the relationships of retinol (ROH), retinol-binding protein (RBP), and transthyretin (TTR) in children with end-stage renal disease (ESRD). Our hypothesis was that levels of ROH and RBP would be elevated in children with ESRD. METHODS AND PATIENTS: We measured ROH, RBP, and TTR serum concentrations in a group of pediatric ESRD patients biannually. Children were grouped according to age and method of dialysis, i.e., hemodialysis (HD) or peritoneal dialysis (PD): HD1, aged <12 years (n = 8); PD1, aged <12 years (n = 19); HD2, aged >or=12 years (n =19); and PD2, aged >or=12 years (n = 29). RESULTS: No differences in ROH, RBP, TTR, or their ratios were found as a function of type of dialysis in groups PD2 and HD2. The ROH and TTR were significantly higher in PD1 than HD1 (P = .01 and P = .003, respectively). No correlations were evident between ROH and RBP or TTR with length of time on dialysis, serum calcium, or serum creatinine, except for group PD2, in which ROH was positively correlated with RBP (P = .025). There were no significant differences among any of the ratios in terms of age or method of dialysis. CONCLUSIONS: The data indicate that children with ESRD exhibit elevated levels of serum ROH, RBP, and TTR, in proportions similar to those reported in the adult ESRD literature. Further study is needed to clarify the consequences of increased ROH in uremic children.

Effect of dialysis on all trans retinoic acid levels in a child with acute promyelocytic leukemia and renal failure.

All trans retinoic acid (ATRA) combined with chemotherapy has become the mainstay of treatment for patients with acute promyelocytic leukemia (APL). Renal dysfunction (RD) is commonly seen in patients with APL. We describe a patient with APL and multi-organ failure, who was on chronic veno-venous hemofiltration followed by hemodialysis (HD) and later peritoneal dialysis (PD), who received ATRA. ATRA levels were assessed as the body clearance of ATRA in children on HD and/or PD was unknown. Neither HD nor PD significantly affected ATRA levels, suggesting that dose modifications of ATRA may not be necessary for children with these forms of renal replacement therapy.