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Prospective Evaluation of the Change of Predialysis Protein‐Bound Uremic Solute Concentration With Postdilution Online Hemodiafiltration
Author(s) -
Meert Natalie,
Waterloos MarieAnne,
Van Landschoot Maria,
Dhondt Annemieke,
Ledebo Ingrid,
Glorieux Griet,
Goeman Jan,
Van der Eycken Johan,
Vanholder Raymond
Publication year - 2010
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2010.01005.x
Subject(s) - chemistry , beta 2 microglobulin , dialysis , hemodialysis , chromatography , medicine
Although protein‐bound uremic compounds have been related to outcome in observational studies, few current dialysis strategies provide more removal of those compounds than standard hemodialysis. We evaluated the evolution of protein‐bound uremic solutes after a switch from high‐flux hemodialysis to postdilution hemodiafiltration ( n = 13). We compared predialysis solute concentration at 4, 5, and 9 weeks versus baseline for several protein‐bound compounds and water‐soluble solutes, as well as for β 2 ‐microglobulin. After 9 weeks of postdilution hemodiafiltration, a significant decrease versus baseline could be detected for total concentration of protein‐bound solutes: p‐cresylsulfate (3.98 ± 1.51–3.17 ± 1.77 mg/dL, −20%, P < 0.01) and 3‐carboxyl‐4‐methyl‐5‐propyl‐2‐furanpropionic acid (0.72 ± 0.52–0.64 ± 0.46 mg/dL, −11%, P < 0.01). For the other protein‐bound solutes, hippuric acid, indoleacetic acid, and indoxylsulfate, no change in total concentration could be detected. The concentration of the middle molecule, β 2 ‐microglobulin, decreased as well after 9 weeks of postdilution hemodiafiltration (24.7 ± 9.3–18.1 ± 6.7 mg/L, −27%, P < 0.01). For water‐soluble compounds, no significant change of concentration was found. Postdilution hemodiafiltration in comparison to high‐flux hemodialysis provided significant reduction of predialysis concentration of protein‐bound compounds, especially those with the highest protein binding, and of β 2 ‐microglobulin, by −11 to −27% in 9 weeks.