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Abstract: TH-PO354

Increasing the Removal of Protein-Bound Uremic Toxins by Hemolipodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Shi, Yuanyuan, Shanghai Ninth People?s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
  • Wang, Yifeng, Shanghai Ninth People?s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
  • Zhu, Qiuyu, Shanghai Ninth People?s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
  • Ding, Feng, Shanghai Ninth People?s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
Background

Protein-bound uremic toxins (PBUTs) accumulate at high plasma levels and cause various deleterious effects in ESRD patients because their removal by conventional hemodialysis (HD) is severely limited by their low free-fraction levels in plasma. Here, we assessed the extent to which solute removal can be increased by adding liposomes to the dialysate.

Methods

A reservoir that contained PBUTs and artificial plasma was used for determinating the adsorption capacity of liposomes for p-cresyl sulfate (PCS), indoxyl sulfate (IS) and hippuric acid (HA). The effect of adding liposomes to the dialysate was then quantified and compared with the effect of adding bovine serum albumin (BSA) to the dialysate and dialysate without addition of any sorbent in a rapid equilibrium dialysis (RED) setup and an in vitro closed HD model respectively. Finally, male Sprague-Dawley rats were subjected to 5/6 nephrectomy and fed for 20 weeks to establish the end stage renal failure. They received HD for 240 min at a blood and dialysate flow rate of 1.0 and 5.0 mL/min, respectively. Removal of solutes was determined by reduction ratios (RRs) and total solute removal (TSR) in dialysate.

Results

The uptake of liposomes by direct incubation in vitro showed an obvious dose-response relationship for PCS and IS but not for HA. The percent removal of both PCS and IS but not of HA was gradually increased with the increased concentration of liposomes in the RED setup. In vitro closed HD circulation showed that adding liposomes to the dialysate markedly increased the clearance of PBUTs without greatly altering that of urea and creatinine. The difference was more noticeable for strongly albumin bound compounds. In vivo experiments in uremic rats demonstrated that adding liposomes to the dialysate resulted in higher reduction ratios (RRs) and more total solute removal (TSR) for several PBUTs compared to the conventional dialysate, which was approximately similar to the addition of BSA to the dialysate. There were no significant differences in RRs and TSR of blood urea nitrogen and creatinine with addition of liposomes or BSA to dialysate compared to conventional dialysis.

Conclusion

As an adjunct to conventional hemodialysis, adding liposomes to the conventional dialysate may significantly improve the removal of protein-bound uremic solutes without greatly altering the removal of small, water-soluble solutes.

Funding

  • Government Support - Non-U.S.