Kidney Week

Abstract: TH-PO753

Direct Hemoperfusion of Protein-Bound Uremic Toxins Using Activated Carbon

Session Information

• Bioengineering
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bioengineering

• 300 Bioengineering

Authors

• Yamamoto, Suguru, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Suguru Yamamoto,

• Itoh, Yoshiharu, Kureha Corp., Tokyo, Japan

Yoshiharu Itoh,

• Ito, Toru, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Toru Ito,

• Kaneko, Yoshikatsu, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Yoshikatsu Kaneko,

• Goto, Shin, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Shin Goto,

• Gejyo, Fumitake, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Fumitake Gejyo,

• Narita, Ichiei, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Ichiei Narita,

Background

Accumulation of protein-bound uremic toxins (PBUTs) is associated with mortality due to various systemic disorders in patients with CKD, especially those undergoing dialysis. The clinical outcomes of such patients could be improved by removing sufficient quantities of PBUTs; however, conventional dialysis lacks this ability. We examined the efficacy of activated carbon in adsorbing circulating PBUTs via direct hemoperfusion in vitro.

Methods

An in vitro blood circulating system composed of 6.5-8.5 mL blood circulating around a column containing activated carbon (50, 100, or 200 mg) was constructed. Bovine blood containing PBUTs at the same concentration as that found in the blood of dialysis patients, as well as blood from hemodialysis patients (n = 8) were used. After circulation for the designated amount of time, sera were collected and the levels of PBUTs, such as indoxyl sulfate (IS), p-crecyl sulfate (PCS), indole acetic acid (IAA), phenyl sulfate (PhS), and hippuric acid (HA), were analyzed with mass spectrometry.

Results

Activated carbon decreased bovine blood PBUT level in a dose and time dependent manner (ex. reduction rate: IS 66.4%, 80.1%, and 93.8% following 60-minute circulation in columns containing 50, 100, and 200 mg of activated carbon, respectively). All tested PBUTs were dramatically adsorbed by activated carbon from the blood of patients undergoing hemodialysis [pre vs post 4-hour circulation: IS median 3.01 (IQR: 2.58-3.38) vs 0.43 (0.41-0.51) mg/dL, PCS 3.34 (0.38-5.15) vs. 0.96 (0.12-1.18) mg/dL, IAA 0.073 (0.057-0.080) vs. 0.018 (0.016-0.019) mg/dL, PhS 0.452 (0.240-0.651) vs. 0.008 (0.004-0.012) mg/dL and HA 1.368 (0.874-1.881) vs. 0.006 (0.004-0.013) mg/dL] (Figure).

Conclusion

Activated carbon effectively adsorbed blood PBUTs in vitro. Direct hemoperfusion with activated carbon could be a promising strategy to remove circulating PBUTs from the blood of patients with CKD.