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Abstract: FR-PO483

Ex Vivo Validation of Allo-Hemodialysis for Removal of Creatinine and Protein-Bound Uremic Toxins

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Chao, Joshua Emmanuel, Renal Research Institute, New York, New York, United States
  • Grobe, Nadja, Renal Research Institute, New York, New York, United States
  • Maheshwari, Vaibhav, Renal Research Institute, New York, New York, United States
  • Tao, Xia, Renal Research Institute, New York, New York, United States
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States

Group or Team Name

  • Renal Research Institute
Background

Unlike conventional hemodialysis, allo-hemodialysis (alloHD) has a patient dialyzed against a healthy subject (“buddy”). This ex vivo study aimed to explore the feasibility of removing creatinine and protein-bound uremic toxins (PBUTs) with alloHD, where whole blood constitutes the “dialysate”.

Methods

Two buckets of whole blood (anticoagulated with 5,000 U/L heparin) were designated as “patient” and “buddy” and dialyzed against each other for 2 hours with initial flow rates of 110 mL/min for both circuits using a high-flux cellulose triacetate dialyzer (Nipro Cellentia 17H, surface area 1.7 m2) and targeting zero net ultrafiltration. The “patient” bucket was initially spiked with creatinine, indoxyl sulfate (IS), and p-cresyl sulfate (pCS) to establish a diffusion gradient between patient and buddy. This was followed by a 2nd spike 1 hour into the experiment. After each spike, blood samples from both sides were collected after each spike every 5 min for 30 min, then every 10 min for the next 30 min. IS and pCS were measured via liquid chromatography–mass spectrometry after liquid-liquid extraction, while creatinine was determined via spectrophotometry.

Results

Solute concentration differences between “buddy” and “patient” dissipated rapidly (Figure 1). As expected, creatinine concentrations equilibrated faster (within about 5 min), while PBUT concentrations equilibrated more slowly (within 15 to 25 minutes), presumably due to their high degree of protein binding. No blood clots were present even after 2 hours of ex vivo recirculation.

Conclusion

This bench experiment demonstrates the ability of alloHD to not only remove water-soluble unbound solutes but also PBUTs. These findings support alloHD’s viability as a potential alternative to conventional hemodialysis.

Funding

  • Commercial Support