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2015 ; 7
(10
): 3933-46
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Exploring Protein Binding of Uremic Toxins in Patients with Different Stages of
Chronic Kidney Disease and during Hemodialysis
#MMPMID26426048
Deltombe O
; Van Biesen W
; Glorieux G
; Massy Z
; Dhondt A
; Eloot S
Toxins (Basel)
2015[Sep]; 7
(10
): 3933-46
PMID26426048
show ga
As protein binding of uremic toxins is not well understood, neither in chronic
kidney disease (CKD) progression, nor during a hemodialysis (HD) session, we
studied protein binding in two cross-sectional studies. Ninety-five CKD 2 to 5
patients and ten stable hemodialysis patients were included. Blood samples were
taken either during the routine ambulatory visit (CKD patients) or from blood
inlet and outlet line during dialysis (HD patients). Total (CT) and free
concentrations were determined of p-cresylglucuronide (pCG), hippuric acid (HA),
indole-3-acetic acid (IAA), indoxyl sulfate (IS) and p-cresylsulfate (pCS), and
their percentage protein binding (%PB) was calculated. In CKD patients, %PB/CT
resulted in a positive correlation (all p < 0.001) with renal function for all
five uremic toxins. In HD patients, %PB was increased after 120 min of dialysis
for HA and at the dialysis end for the stronger (IAA) and the highly-bound (IS
and pCS) solutes. During one passage through the dialyzer at 120 min, %PB was
increased for HA (borderline), IAA, IS and pCS. These findings explain why
protein-bound solutes are difficult to remove by dialysis: a combination of the
fact that (i) only the free fraction can pass the filter and (ii) the
equilibrium, as it was pre-dialysis, cannot be restored during the dialysis
session, as it is continuously disturbed.
free
free
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