title: Enhanced Indoxyl Sulfate Dialyzer Clearance with the Use of Binding Competitors.
abstract: BACKGROUND
  Indoxyl sulfate is a protein-bound uremic toxin and its dialytic clearance is comparatively low. We propose a method to increase indoxyl sulfate dialytic clearance.
  
  
  METHODS
  Human serum albumin, preloaded with indoxyl sulfate, was circulated on the blood side of an F40S dialyzer with single-pass counter-current dialysate flow. Tryptophan or docosahexaenoic acid (DHA), which are binding competitors to indoxyl sulfate, were infused into the blood-side circuit upstream of the dialyzer, and their abilities to increase the removal of indoxyl sulfate determined.
  
  
  RESULTS
  Baseline indoxyl sulfate removal was 10.2 ± 0.3%, which increased to 18.5 ± 0.4% with infusion of tryptophan (p < 0.001) and 27.7 ± 1.0% with infusion of DHA (p < 0.001).
  
  
  CONCLUSIONS
  This study shows that tryptophan and DHA effectively increase indoxyl sulfate removal in an in vitro dialysis model. The concept of using binding competitors to enhance the clearance of protein-bound uremic toxins could be applied to current hemodialysis technology.
authors.affiliation: The Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, Mass., USA.
authors.forename: Xia
authors.initials: X
authors.lastname: Tao
authors.forename: Stephan
authors.initials: S
authors.lastname: Thijssen
authors.forename: Nathan
authors.initials: N
authors.lastname: Levin
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.forename: Garry
authors.initials: G
authors.lastname: Handelman
mesh_terms: D000418:Albumins / Q000378:metabolism; D001667:Binding, Competitive; D002851:Chromatography, High Pressure Liquid; D015314:Dialysis Solutions / Q000737:chemistry; D006801:Humans; D007200:Indican / Q000737:chemistry / Q000378:metabolism; D007700:Kinetics; D011485:Protein Binding; D006435:Renal Dialysis / Q000379:methods
chemical_list: D000418:Albumins; D015314:Dialysis Solutions; D007200:Indican