Removal of Protein-Bound Uremic Toxins during Hemodialysis Using a Binding Competitor
| Autor: | Jillian Brown, Peter Kotanko, Garry J. Handelman, Beatriz Cornejo, Karla B. Cano, Vaibhav Maheshwari, Magdalena Madero, Xia Tao, Israel Campos, Stephan Thijssen |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Epidemiology medicine.medical_treatment 030232 urology & nephrology Ibuprofen Serum Albumin Human Indican Sulfuric Acid Esters Critical Care and Intensive Care Medicine Binding Competitive Cresols 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Renal Dialysis Interquartile range Internal medicine medicine Infusions Intra-Arterial Humans Sulfate Uremia Toxins Biological 030304 developmental biology 0303 health sciences Transplantation Creatinine business.industry Albumin Original Articles Middle Aged Treatment Outcome Editorial Endocrinology chemistry Nephrology Urea Female Hemodialysis business Protein Binding medicine.drug |
| Zdroj: | Clinical Journal of the American Society of Nephrology. 14:394-402 |
| ISSN: | 1555-905X 1555-9041 |
| DOI: | 10.2215/cjn.05240418 |
| Popis: | BACKGROUND AND OBJECTIVES: Current hemodialysis techniques fail to efficiently remove the protein-bound uremic toxins p-cresyl sulfate and indoxyl sulfate due to their high degree of albumin binding. Ibuprofen, which shares the same primary albumin binding site with p-cresyl sulfate and indoxyl sulfate, can be infused during hemodialysis to displace these toxins, thereby augmenting their removal. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We infused 800 mg ibuprofen into the arterial bloodline between minutes 21 and 40 of a conventional 4-hour high-flux hemodialysis treatment. We measured arterial, venous, and dialysate outlet concentrations of indoxyl sulfate, p-cresyl sulfate, tryptophan, ibuprofen, urea, and creatinine before, during, and after the ibuprofen infusion. We report clearances of p-cresyl sulfate and indoxyl sulfate before and during ibuprofen infusion and dialysate concentrations of protein-bound uremic toxins normalized to each patient’s average preinfusion concentrations. RESULTS: We studied 18 patients on maintenance hemodialysis: age 36±11 years old, ten women, and mean vintage of 37±37 months. Compared with during the preinfusion period, the median (interquartile range) clearances of indoxyl sulfate and p-cresyl sulfate increased during ibuprofen infusion from 6.0 (6.5) to 20.2 (27.1) ml/min and from 4.4 (6.7) to 14.9 (27.1) ml/min (each P |
| Databáze: | OpenAIRE |
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