American Journal of Kidney Diseases
Volume 53, Issue 6 , Pages 1042-1049 , June 2009

Effect of Increasing Dialyzer Mass Transfer Area Coefficient and Dialysate Flow on Clearance of Protein-Bound Solutes: A Pilot Crossover Trial

  • Frank J.-G. Luo, MD

      Affiliations

    • Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA
    • Corresponding Author InformationAddress correspondence to Frank J.-G. Luo, MD, Nephrology 111R, Palo Alto VAHCS, 3801 Miranda Ave, Palo Alto, CA 94303
    • ,
  • Kajal P. Patel, MD

      Affiliations

    • Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA
    • ,
  • Ilian O. Marquez, MD

      Affiliations

    • Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA
    • ,
  • Natalie S. Plummer, MA

      Affiliations

    • Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA
    • ,
  • Thomas H. Hostetter, MD

      Affiliations

    • Department of Medicine, Albert Einstein College of Medicine, New York, NY
    • ,
  • Timothy W. Meyer, MD

      Affiliations

    • Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA

Received 24 August 2008 ,Accepted 14 January 2009.

References 

  1. Vanholder R, De Smet R, Lameire N. Protein-bound uremic solutes: The forgotten toxins. Kidney Int Suppl. 2001;78:S266–S270
  2. Bammens B, Evenepoel P, Verbeke K, Vanrenterghem Y. Removal of the protein-bound solute p-cresol by convective transport: A randomized crossover study. Am J Kidney Dis. 2004;44:278–285
  3. De Smet R, Dhondt A, Eloot S, Galli F, Waterloos MA, Vanholder R. Effect of the super-flux cellulose triacetate dialyser membrane on the removal of non-protein-bound and protein-bound uraemic solutes. Nephrol Dial Transplant. 2007;22:2006–2012
  4. Martinez AW, Recht NS, Hostetter TH, Meyer TW. Removal of p-cresol sulfate by hemodialysis. J Am Soc Nephrol. 2005;16:3430–3436
  5. Brunet P, Dou L, Cerini C, Berland Y. Protein-bound uremic retention solutes. Adv Ren Replace Ther. 2003;10:310–320
  6. Meyer TW, Leeper EC, Bartlett DW, et al. Increasing dialysate flow and dialyzer mass transfer area coefficient to increase the clearance of protein-bound solutes. J Am Soc Nephrol. 2004;15:1927–1935
  7. Meyer TW, Walther JL, Pagtalunan ME, et al. The clearance of protein-bound solutes by hemofiltration and hemodiafiltration. Kidney Int. 2005;68:867–877
  8. Mackay GM, Forrest CM, Stoy N, et al. Tryptophan metabolism and oxidative stress in patients with chronic brain injury. Eur J Neurol. 2006;13:30–42
  9. Michaels AS. Operating parameters and performance criteria for hemodialyzers and other membrane-separation devices. Trans Am Soc Artif Intern Organs. 1966;12:387–392
  10. Fagugli RM, De Smet R, Buoncristiani U, Lameire N, Vanholder R. Behavior of non-protein-bound and protein-bound uremic solutes during daily hemodialysis. Am J Kidney Dis. 2002;40:339–347
  11. Lesaffer G, De Smet R, Lameire N, Dhondt A, Duym P, Vanholder R. Intradialytic removal of protein-bound uraemic toxins: Role of solute characteristics and of dialyser membrane. Nephrol Dial Transplant. 2000;15:50–57
  12. Langsdorf LJ, Krankel LG, Zydney AL. Effect of blood-membrane interactions on solute clearance during hemodialysis. ASAIO J. 1993;39:M767–M772
  13. Depner TA, Greene T, Daugirdas JT, Cheung AK, Gotch FA, Leypoldt JK. Dialyzer performance in the HEMO Study: In vivo K0A and true blood flow determined from a model of cross-dialyzer urea extraction. ASAIO J. 2004;50:85–93
  14. Eloot S, Torremans A, De Smet R, et al. Complex compartmental behavior of small water-soluble uremic retention solutes: Evaluation by direct measurements in plasma and erythrocytes. Am J Kidney Dis. 2007;50:279–288
  15. Meijers BK, Weber V, Bammens B, et al. Removal of the uremic retention solute p-cresol using fractionated plasma separation and adsorption. Artif Organs. 2008;32:214–219
  16. De Smet R, Van Kaer J, Van Vlem B, et al. Toxicity of free p-cresol: A prospective and cross-sectional analysis. Clin Chem. 2003;49:470–478
  17. Bammens B, Evenepoel P, Keuleers H, Verbeke K, Vanrenterghem Y. Free serum concentrations of the protein-bound retention solute p-cresol predict mortality in hemodialysis patients. Kidney Int. 2006;69:1081–1087
  18. Schepers E, Meert N, Glorieux G, Goeman J, Van der Eycken J, Vanholder R. p-Cresylsulphate, the main in vivo metabolite of p-cresol, activates leucocyte free radical production. Nephrol Dial Transplant. 2007;22:592–596
  19. Dou L, Jourde-Chiche N, Faure V, et al. The uremic solute indoxyl sulfate induces oxidative stress in endothelial cells. J Thromb Haemost. 2007;5:1302–1308
  20. Taki K, Tsuruta Y, Niwa T. Indoxyl sulfate and atherosclerotic risk factors in hemodialysis patients. Am J Nephrol. 2007;27:30–35

 Originally published online as doi:10.1053/j.ajkd.2009.01.265 on April 27, 2009.

PII: S0272-6386(09)00437-5

doi: 10.1053/j.ajkd.2009.01.265

American Journal of Kidney Diseases
Volume 53, Issue 6 , Pages 1042-1049 , June 2009

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