Serum levels and removal by haemodialysis and haemodiafiltration of tryptophan-derived uremic toxins in ESKD patients

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Serum levels and removal by haemodialysis and haemodiafiltration of tryptophan-derived uremic toxins in ESKD patients. / Paats, Joosep; Adoberg, Annika; Arund, Jürgen; Dhondt, Annemieke; Fernström, Anders; Fridolin, Ivo; Glorieux, Griet; Leis, Liisi; Luman, Merike; Gonzalez-Parra, Emilio; Perez-Gomez, Vanessa Maria; Pilt, Kristjan; Sanchez-Ospina, Didier; Segelmark, Mårten; Uhlin, Fredrik; Ortiz, Alberto Arduan.

In: International Journal of Molecular Sciences, Vol. 21, No. 4, 1522, 2020.

Research output: Contribution to journalArticle

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Paats, J, Adoberg, A, Arund, J, Dhondt, A, Fernström, A, Fridolin, I, Glorieux, G, Leis, L, Luman, M, Gonzalez-Parra, E, Perez-Gomez, VM, Pilt, K, Sanchez-Ospina, D, Segelmark, M, Uhlin, F & Ortiz, AA 2020, 'Serum levels and removal by haemodialysis and haemodiafiltration of tryptophan-derived uremic toxins in ESKD patients', International Journal of Molecular Sciences, vol. 21, no. 4, 1522. https://doi.org/10.3390/ijms21041522

APA

CBE

Paats J, Adoberg A, Arund J, Dhondt A, Fernström A, Fridolin I, Glorieux G, Leis L, Luman M, Gonzalez-Parra E, Perez-Gomez VM, Pilt K, Sanchez-Ospina D, Segelmark M, Uhlin F, Ortiz AA. 2020. Serum levels and removal by haemodialysis and haemodiafiltration of tryptophan-derived uremic toxins in ESKD patients. International Journal of Molecular Sciences. 21(4). https://doi.org/10.3390/ijms21041522

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Paats, Joosep ; Adoberg, Annika ; Arund, Jürgen ; Dhondt, Annemieke ; Fernström, Anders ; Fridolin, Ivo ; Glorieux, Griet ; Leis, Liisi ; Luman, Merike ; Gonzalez-Parra, Emilio ; Perez-Gomez, Vanessa Maria ; Pilt, Kristjan ; Sanchez-Ospina, Didier ; Segelmark, Mårten ; Uhlin, Fredrik ; Ortiz, Alberto Arduan. / Serum levels and removal by haemodialysis and haemodiafiltration of tryptophan-derived uremic toxins in ESKD patients. In: International Journal of Molecular Sciences. 2020 ; Vol. 21, No. 4.

RIS

TY - JOUR

T1 - Serum levels and removal by haemodialysis and haemodiafiltration of tryptophan-derived uremic toxins in ESKD patients

AU - Paats, Joosep

AU - Adoberg, Annika

AU - Arund, Jürgen

AU - Dhondt, Annemieke

AU - Fernström, Anders

AU - Fridolin, Ivo

AU - Glorieux, Griet

AU - Leis, Liisi

AU - Luman, Merike

AU - Gonzalez-Parra, Emilio

AU - Perez-Gomez, Vanessa Maria

AU - Pilt, Kristjan

AU - Sanchez-Ospina, Didier

AU - Segelmark, Mårten

AU - Uhlin, Fredrik

AU - Ortiz, Alberto Arduan

PY - 2020

Y1 - 2020

N2 - Tryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS) and indole acetic acid (IAA), in ESKD patients in different dialysis treatment settings. This prospective multicentre study in four European dialysis centres enrolled 78 patients with ESKD. Blood and spent dialysate samples obtained during dialysis were analysed with high-performance liquid chromatography to assess uremic solutes, their reduction ratio (RR) and total removed solute (TRS). Mean free serum tryptophan and IS concentrations increased, and concentration of IAA decreased over pre-dialysis levels (67%, 49%, −0.8%, respectively) during the first hour of dialysis. While mean serum total urea, IS and IAA concentrations decreased during dialysis (−72%, −39%, −43%, respectively), serum tryptophan levels increased, resulting in negative RR (−8%) towards the end of the dialysis session (p < 0.001), despite remarkable Trp losses in dialysate. RR and TRS values based on serum (total, free) and dialysate solute concentrations were lower for conventional low-flux dialysis (p < 0.001). High-efficiency haemodiafiltration resulted in 80% higher Trp losses than conventional low-flux dialysis, despite similar neutral Trp RR values. In conclusion, serum Trp concentrations and RR behave differently from uremic solutes IS, IAA and urea and Trp RR did not reflect dialysis Trp losses. Conventional low-flux dialysis may not adequately clear Trp-related uremic toxins while high efficiency haemodiafiltration increased Trp losses.

AB - Tryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS) and indole acetic acid (IAA), in ESKD patients in different dialysis treatment settings. This prospective multicentre study in four European dialysis centres enrolled 78 patients with ESKD. Blood and spent dialysate samples obtained during dialysis were analysed with high-performance liquid chromatography to assess uremic solutes, their reduction ratio (RR) and total removed solute (TRS). Mean free serum tryptophan and IS concentrations increased, and concentration of IAA decreased over pre-dialysis levels (67%, 49%, −0.8%, respectively) during the first hour of dialysis. While mean serum total urea, IS and IAA concentrations decreased during dialysis (−72%, −39%, −43%, respectively), serum tryptophan levels increased, resulting in negative RR (−8%) towards the end of the dialysis session (p < 0.001), despite remarkable Trp losses in dialysate. RR and TRS values based on serum (total, free) and dialysate solute concentrations were lower for conventional low-flux dialysis (p < 0.001). High-efficiency haemodiafiltration resulted in 80% higher Trp losses than conventional low-flux dialysis, despite similar neutral Trp RR values. In conclusion, serum Trp concentrations and RR behave differently from uremic solutes IS, IAA and urea and Trp RR did not reflect dialysis Trp losses. Conventional low-flux dialysis may not adequately clear Trp-related uremic toxins while high efficiency haemodiafiltration increased Trp losses.

KW - Chronic kidney disease

KW - End-stage kidney disease

KW - Haemodiafiltration

KW - Haemodialysis

KW - Indole-3 acetic acid

KW - Indoxyl sulfate

KW - Tryptophan

KW - Tryptophan-derived uremic toxins

KW - Uremic toxins

U2 - 10.3390/ijms21041522

DO - 10.3390/ijms21041522

M3 - Article

VL - 21

JO - International Journal of Molecular Sciences

JF - International Journal of Molecular Sciences

SN - 1422-0067

IS - 4

M1 - 1522

ER -