Kidney Week

Abstract: SA-PO744

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

Session Information

• Standard Hemodialysis for ESRD - I
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 601 Standard Hemodialysis for ESRD

Authors

• Cano Escobar, Karla Bernice, INCIC, Mexico, Mexico

Karla Bernice Cano Escobar,

• Tao, Xia, Renal Research Institute, New York, New York, United States

Xia Tao,

• Campos, Israel, Renal Research Institute, New York, New York, United States

Israel Campos,

• Maheshwari, Vaibhav, Renal Research Insitute, New York, New York, United States

Vaibhav Maheshwari,

• Brown, Jillian, University of Massachusetts, Lowell, Massachusetts, United States

Jillian Brown,

• Handelman, Garry J., University of Massachusetts, Lowell, Massachusetts, United States

Garry J. Handelman,

• Thijssen, Stephan, Renal Research Institute, New York, New York, United States

Stephan Thijssen,

• Kotanko, Peter, Renal Research Insitute, New York, New York, United States

Peter Kotanko,

• CORNEJO MEDELLIN, BEATRIZ ESPERANZA, INCIC, Mexico, Mexico

BEATRIZ ESPERANZA CORNEJO MEDELLIN,

• Madero, Magdalena, INCIC, Mexico, Mexico

Magdalena Madero,

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(Q_b300 mL/min;Q_d500 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