title: Clearance of p-cresol sulfate and β-2-microglobulin from dialysate by commercially available sorbent technology.
abstract: Dialysate regeneration by sorbents is an alternative to conventional single-pass dialysis. Little is known about the capacity of sorbents to clear dialysate of “middle molecules” and protein-bound uremic toxins. We studied p-cresol sulfate (PCS) and β-2-microglobulin (β2M) removal from dialysate by a sorbent: 1. PCS (40 mg PCS dissolved in 4 L of fresh dialysate) was recirculated through a sorbent cartridge (SORB Technology, Inc.) for analysis of PCS removal. 2. Spent peritoneal dialysate was recirculated on the “blood” side of a high-flux dialyzer. On the “dialysate” side of the membrane, bicarbonate dialysate was recirculated through a sorbent cartridge. β2M was measured in both streams. Two results are of particular importance for the use of regenerated fluid in chronic dialysis: 1. PCS was virtually completely removed from the dialysate. On average, PCS concentration was reduced to 1.4% of the starting concentration after 60 minutes. PCS extraction across the sorbent was nearly complete at any time. 2. β2M was on average reduced to 14.3% of the starting concentration after 60 minutes. Postsorbent concentrations were consistently below the validated range of the test method. We conclude that PCS and β2M are efficiently removed from the dialysate by commercially available sorbent technology. Spent peritoneal dialysis fluid can be cleared of β2M when circulated against sorbent-regenerated dialysate using a high-flux membrane.
authors.affiliation: Renal Research Institute, New York, New York; †Beth Israel Medical Center, New York, New York 10128, USA.
authors.forename: Anja
authors.initials: A
authors.lastname: Kruse
authors.forename: Xia
authors.initials: X
authors.lastname: Tao
authors.forename: Viraj
authors.initials: V
authors.lastname: Bhalani
authors.forename: Garry
authors.initials: G
authors.lastname: Handelman
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.forename: Stephan
authors.initials: S
authors.lastname: Thijssen
mesh_terms: D000327:Adsorption; D001709:Biotechnology; D002606:Charcoal; D003408:Cresols / Q000302:isolation & purification*; D015314:Dialysis Solutions / Q000032:analysis; D006801:Humans; D066298:In Vitro Techniques; D007688:Kidneys, Artificial; D010530:Peritoneal Dialysis / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods; D013463:Sulfuric Acid Esters / Q000302:isolation & purification*; D014118:Toxins, Biological / Q000302:isolation & purification; D014511:Uremia / Q000378:metabolism / Q000628:therapy; D001613:beta 2-Microglobulin / Q000302:isolation & purification*
chemical_list: D003408:Cresols; D015314:Dialysis Solutions; D013463:Sulfuric Acid Esters; D014118:Toxins, Biological; D001613:beta 2-Microglobulin; C026865:uremia middle molecule toxins; D002606:Charcoal; C408690:4-cresol sulfate