Prospective evaluation of the change of predialysis protein-bound uremic solute concentration with postdilution online hemodiafiltration.
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 beta(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, beta(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 beta(2)-microglobulin, by -11 to -27% in 9 weeks.
Meert
Natalie
N
Renal Division, University Hospital Ghent, Ghent, Belgium.
Waterloos
Marie-Anne
MA
Van Landschoot
Maria
M
Dhondt
Annemieke
A
Ledebo
Ingrid
I
Glorieux
Griet
G
Goeman
Jan
J
Van der Eycken
Johan
J
Vanholder
Raymond
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000378:metabolism*; D017583:Hemodiafiltration / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011485:Protein Binding; D012709:Serum Albumin / Q000378:metabolism; D014508:Urea / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism*; D001613:beta 2-Microglobulin / Q000378:metabolism
D001798:Blood Proteins; D012709:Serum Albumin; D001613:beta 2-Microglobulin; D014508:Urea