title: Protein-bound toxins: added value in their removal with high convective volumes.
abstract: Chronic kidney disease is associated with an increased risk of cardiovascular events. In recent years, protein-bound toxins have become more important due to their association with increased morbidity and mortality, characterised by inadequate clearance during dialysis. The purpose of this study is to assess the influence of high convective volumes on postdilution online haemodiafiltration (OL-HDF) on the removal of medium-sized molecules, small molecules and protein-bound molecules.
  
  
  METHODS
  In forty postdilutional OL-HDF sessions, the reduction rates of toxins of different molecular weights were measured in 13 patients, including protein-bound molecules such as p-cresyl sulphate, indoxyl sulphate and homocysteine.
  
  
  RESULTS
  Total convective volume was 28.3 (5.1) litres (range 16.3-38.0 litres). Mean reduction rate of protein-bound molecules was 44.4% (15.7%), 48.7% (14.1%) and 58.6% (8.8%) for p-cresyl sulphate, indoxyl sulphate and homocysteine, respectively. Moreover, a statistically significant direct association was found between the reduction rates of all three molecules, the replacement volume and the Kt/V.
  
  
  CONCLUSIONS
  High convective volumes during postdilution OL-HDF are associated with increased removal of protein-bound uraemic toxins.
authors: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: sora.abad@gmail.com.
authors: Soraya
authors: S
authors: Abad
authors: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Almudena
authors: A
authors: Vega
authors: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Borja
authors: B
authors: Quiroga
authors: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: David
authors: D
authors: Arroyo
authors: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Nayara
authors: N
authors: Panizo
authors: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Javier Eduardo
authors: JE
authors: Reque
authors: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Juan Manuel
authors: JM
authors: López-Gómez
mesh_terms: D017583:Hemodiafiltration; D006801:Humans; D008970:Molecular Weight; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*
keywords: Alto volumen convectivo; Hemodiafiltración on-line; High convective volumes; Indoxyl sulfato; Indoxyl sulphate; Online haemodiafiltration; Protein-bound toxins; Toxinas unidas a proteínas; p-cresyl sulfato; p-cresyl sulphate