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Kidney Week

Abstract: PO1171

Tryptophan Removal in ESRD Patients Treated with High-Flux and Medium Cut-Off Dialyzers During Hemodialysis and Hemodiafiltration

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Dias, Gabriela Ferreira, Renal Research Institute, New York, New York, United States
  • Grobe, Nadja, Renal Research Institute, New York, New York, United States
  • Peng, Peiying, Renal Research Institute, New York, New York, United States
  • Wang, Xiaoling, Renal Research Institute, New York, New York, United States
  • Chao, Joshua Emmanuel, Renal Research Institute, New York, New York, United States
  • Lopez Gil, Jose S., Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Estado de Mexico, Mexico
  • Armenta álvarez, Armando, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Estado de Mexico, Mexico
  • Madero, Magdalena, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Estado de Mexico, Mexico
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Tao, Xia, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

Tryptophan (Trp) loss in kidney failure patients is likely to be associated with poor nutritional status and depletion due to dialysis. However, Trp removal with medium cutoff (MCO) membranes has not been investigated. Here, we compared Trp reduction ratios (RR) between an MCO dialyzer and a high-flux polysulfone (HFPS) dialyzer

Methods

Clinically stable, anuric hemodialysis patients on thrice-weekly HD were enrolled. Over the course of 4 weeks, each subject traversed through the following combinations (with 2 study treatments per week, 4 hours per HD session): post-dilution hemodiafiltration (HDF) with FX120 (Fresenius Medical Care), HD with FX120, HDF with Theranova 400 (Baxter), HD with Theranova 400 (Fig. 1). All subjects exercised using stationary bicycles during HD. Blood samples were collected before dialysis (B0) and at 230 min (B230) upstream of the dialyzer. Trp in plasma was analyzed by liquid chromatography–mass spectrometry. RR was calculated using signal intensities for Trp according to RR=(B0-B230)/B0, with correction for hemoconcentration using hemoglobin levels (Schneditz, ASAIO 2012)

Results

Twelve subjects completed the study (50% female, 43.8±18.5 years old). With HD, RR was comparable between the MCO dialyzer and the larger HFPS dialyzer (median RR 0.29 for MCO, 0.33 for HFPS; surface areas 1.7 m2 vs. 2.5 m2, respectively). In HDF, our data suggest somewhat greater Trp loss with the MCO dialyzer despite its smaller surface area compared to the HFPS dialyzer

Conclusion

Use of an MCO dialyzer may result in similar or greater Trp loss as use of an HFPS dialyzer with a much larger surface area. When considering the use of MCO dialyzers, clinicians should consider the potential impact on removal of salutary substances (incl. protein-bound substances), an area that deserves further research

Figure 2. Box-Whisker plot of Trp RR.

Fig 1. Design of clinical study.

Funding

  • Private Foundation Support