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Medientyp:
E-Artikel
Titel:
Removal of Protein‐Bound, Hydrophobic Uremic Toxins by a Combined Fractionated Plasma Separation and Adsorption Technique
Beteiligte:
Brettschneider, Falko;
Tölle, Markus;
von der Giet, Markus;
Passlick‐Deetjen, Jutta;
Steppan, Sonja;
Peter, Mirjam;
Jankowski, Vera;
Krause, Alfred;
Kühne, Sophie;
Zidek, Walter;
Jankowski, Joachim
Erschienen:
Wiley, 2013
Erschienen in:Artificial Organs
Sprache:
Englisch
DOI:
10.1111/j.1525-1594.2012.01570.x
ISSN:
0160-564X;
1525-1594
Entstehung:
Anmerkungen:
Beschreibung:
<jats:title>Abstract</jats:title><jats:p>Protein‐bound uremic toxins, such as phenylacetic acid, indoxyl sulfate, and p‐cresyl sulfate, contribute substantially to the progression of chronic kidney disease (<jats:styled-content style="fixed-case">CKD</jats:styled-content>) and cardiovascular disease (<jats:styled-content style="fixed-case">CVD</jats:styled-content>). However, based on their protein binding, these hydrophobic uremic toxins are poorly cleared during conventional dialysis and thus accumulate in <jats:styled-content style="fixed-case">CKD</jats:styled-content>‐5<jats:styled-content style="fixed-case">D</jats:styled-content> patients. Therefore, we investigated whether hydrophobic and cationic adsorbers are more effective for removal of protein‐bound, hydrophobic uremic toxins than conventional high‐flux hemodialyzer. Five <jats:styled-content style="fixed-case">CKD</jats:styled-content>‐5<jats:styled-content style="fixed-case">D</jats:styled-content> patients were treated using the fractionated plasma separation, adsorption, and dialysis (<jats:styled-content style="fixed-case">FPAD</jats:styled-content>) system for 5 h. A control group of five <jats:styled-content style="fixed-case">CKD</jats:styled-content> patients was treated with conventional high‐flux hemodialysis. Plasma concentrations of phenylacetic acid, indoxyl sulfate, and p‐cresyl sulfate were measured. Removal rates of <jats:styled-content style="fixed-case">FPAD</jats:styled-content> treatment in comparison to conventional high‐flux hemodialysis were increased by 130% for phenylacetic acid, 187% for indoxyl sulfate, and 127% for p‐cresol. <jats:styled-content style="fixed-case">FPAD</jats:styled-content> treatment was tolerated well in terms of clinically relevant biochemical parameters. However, patients suffered from mild nausea 2 h after the start of the treatment, which persisted until the end of treatment. Due to the high impact of protein‐bound, hydrophobic uremic toxins on progression of <jats:styled-content style="fixed-case">CKD</jats:styled-content> and <jats:styled-content style="fixed-case">CVD</jats:styled-content> in <jats:styled-content style="fixed-case">CKD</jats:styled-content>‐5<jats:styled-content style="fixed-case">D</jats:styled-content> patients, the use of an adsorber in combination with dialysis membranes may be a new therapeutic option to increase the removal rate of these uremic toxins. However, larger, long‐term prospective clinical trials are needed to demonstrate the impact on clinical outcome.</jats:p>