Abstract: SA-PO744

Displacer-Enhanced Dialytic Removal of Protein-Bound Uremic Toxins during Hemodialysis

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Cano Escobar, Karla Bernice, INCIC, Mexico, Mexico
  • Madero, Magdalena, INCIC, Mexico, Mexico
  • Tao, Xia, Renal Research Institute, New York, New York, United States
  • Campos, Israel, Renal Research Institute, New York, New York, United States
  • Maheshwari, Vaibhav, Renal Research Insitute, New York, New York, United States
  • Brown, Jillian, University of Massachusetts, Lowell, Massachusetts, United States
  • Handelman, Garry J., University of Massachusetts, Lowell, Massachusetts, United States
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Insitute, New York, New York, United States
  • CORNEJO MEDELLIN, BEATRIZ ESPERANZA, INCIC, Mexico, Mexico
Background

Hemodialysis(HD) has limited efficiency on protein-bound uremic toxins(PBUTs) removal due to their high albumin binding.Binding competitors to PBUTs(“displacers”) such as ibuprofen(IBF) can increase the free concentration of PBUTs and enhance dialytic removal.We investigated if infusion of IBF improves the dialytic removal of p-cresyl sulfate(pCS) and indoxyl sulfate(IS)

Methods

Chronic HD patients(National Institute of Cardiology, Mexico City) were studied during a mid-week HD on their standard prescriptions(Qb300 mL/min;Qd500 mL/min).IBF(800 mg) was infused at a constant rate into the arterial line,from 20 to 40 minutes into the treatment.Dialysate levels of IS, pCS, IBF, tryptophan(TRP) were measured by HPLC. Concentration data were normalized to the respective patient mean levels, which are reported as mean±SD and were compared before, during and after IBF infusion

Results

Seventeen patients were included(10 females,mean age 36±11 years;HD vintage 24 (3-111) months).IBF infusion was well tolerated.Mean of relative levels in the dialysate outlet before, during and after IBF infusion were 0.67±0.23,1.42±0.14, and 0.61±0.19 for IS, 0.63±0.24,1.42±0.15, and 0.64±0.19 for pCS, respectively, indicating a marked increase of dialytic PBUT removal during IBF infusion.Creatinine and urea, non-protein bound control solutes, continued to decline during the IBF infusion, while TRP, a moderately protein bound molecule, increased non-significantly(Fig.1)

Conclusion

This first-in-man study shows that IBF as a displacer during HD significantly enhanced the dialytic removal of PBUTs.These results should stimulate the search for safe and effective molecules that may be used as displacers during HD