Optical Online Monitoring of Uric Acid Removal during Dialysis

Jerotskaja, Jana; Uhlin, Fredrik; Fridolin, Ivo; Lauri, Kai; Luman, Merike; Fernström, Anders

doi:10.1159/000264269

Cited by 20 publications

(14 citation statements)

References 26 publications

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“…In those previous studies, concentrations and UV absorbance were utilized to estimate total removal of the particular solute [15,16]. As in other studies [9], our study showed a different appearance of the elimination curve for phosphate than urea and uric acid.…”

Section: Discussionmentioning

confidence: 50%

“…drain tube) of the dialysis machine, as in earlier studies [15,16,17], with all spent dialysate and ultrafiltrate passing through a rectangular optical flow cuvette (JASCO) with a path length of 10 mm. To find out if it would be possible to create a specific single-wavelength model for phosphate similarly to an earlier study [17], a single wavelength of 297 nm was selected using a bandwidth of 2 nm.…”

Section: Methodsmentioning

confidence: 99%

“…Our primary goal with this study was to find out if it is possible to estimate the elimination of phosphate during ongoing dialysis treatment with UV absorbance in a similar way that earlier has been shown for urea and uric acid [15,16]. …”

Section: Introductionmentioning

confidence: 99%

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Utilization of UV Absorbance for Estimation of Phosphate Elimination during Hemodiafiltration

et al. 2012

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Background: Phosphate is an important factor in explaining the high progress of vascular calcification among dialysis patients. Today, phosphate concentration is measured in plasma on a regular basis. The aim of this study was to find out if it is possible to estimate total removed phosphate (TRp) in spent dialysate utilizing UV absorbance during hemodiafiltration. Methods: Eleven patients were monitored online with UV absorbance at 297 nm, three times during one week each (n = 33). Dialysate samples were taken at different times during treatment and from a collection tank to chemically determine phosphate concentrations. Two mathematical models (UVIND and UVGROUP) were tested to estimate TRp with supervision by UV absorbance and compared with TRp measured in the tank (reference). Results: High correlation between UV absorbance and phosphate concentration for each single patient and lower for the whole group together was found. TRp was (mean ± SD) 30.7 ± 7.3 mmol for the reference and 30.8 ± 8.2 and 29.1 ± 5.2 mmol for UVIND and UVGROUP, respectively (p > 0.05). Conclusion: This study demonstrates a novel possibility to estimate TRp based on linear relationship between online monitoring of UV absorbance and concentration of phosphate in spent dialysate.

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Section: Discussionmentioning

confidence: 50%

Section: Methodsmentioning

confidence: 99%

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Utilization of UV Absorbance for Estimation of Phosphate Elimination during Hemodiafiltration

et al. 2012

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“…This indicates that a model, which uses dialysate values, could receive values from an optical monitoring system [20][21][22][23], enabling continuous monitoring of the dialysis efficacy and prognosis for patient's outcome. Optical monitoring of the urea based dialysis dose is considered as a valid and beneficial alternative to the existing methods [24].…”

Section: Discussionmentioning

confidence: 99%

Estimation of dialysis patients’ survival through combined approach of small molecule uremic markers

Holmar¹,

Fridolin²,

Uhlin³

et al. 2014

Proc. Estonian Acad. Sci.

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Survival rate of dialysis patients is still alarmingly low and various factors may have in it an important role. The purpose of this study was to observe the relationship between the survival of dialysis patients and the serum level of urea, creatinine, and uric acid (UA). Serum urea and creatinine concentrations may express patient's nutritional status and muscle mass, and high UA value may refer to higher risk for cardiovascular events. The idea of combining the concentrations and removal of urea and UA into a single model for predicting the patient's outcome is introduced. The study included 33 hemodialysis patients from Linköping, Sweden and 10 from Tallinn, Estonia. Kaplan-Meier analysis was used for survival analysis. Logistic and Cox regression analysis was applied to create models for predicting patients' three-year survival. It was observed that higher serum UA is significantly related to poor survival in dialysis patients (p = 0.026). A reverse effect was observed in case of urea (p = 0.095). The level of creatinine was not related to survival (p = 0.905). The best logistic regression model for predicting patients' outcome included both UA and urea based parameters (Chi Square 21.0, p = 0.0001). Survival of dialysis patients seems to be determined by a set of causal factors and combined models may have a predictive relevance. A possibility for automatic online monitoring of small molecule uremic markers is proposed. Since the number of participating patients was small, larger studies including more patients and testing the models in independent validation cohort is the future goal.

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“…The wavelength of 280 nm is commonly used in optical dialysis adequacy sensors for this purpose [10] and UA appears to be the main chromophore at this wavelenth among variety of metabolites, eliminated from the blood of end-stage renal disease (ESRD) patients by dialysis [11]. The decline of the absorbance of spent dialysate at 280 nm during dialysis session reflects quite well the removal of all small water-soluble uremic toxins and PAR with its absorbance maximum near 254 nm do not seem to substantially interfere with optical monitoring of elimination of this group of solutes from the blood of patients with end-stage kidney disease [12].…”

Section: Introductionmentioning

confidence: 99%

Paracetamol Interference in Uric Acid Levels in Uremic Patients Revealed by Monitoring Spent Dialysate

et al. 2013

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The aim of this study was to assess removal dynamics of paracetamol (PAR), as an extraordinary chromophore in spent dialysate, upon the optical monitoring of dialysis of end-stage renal disease patients with inflammation complications. Seven dialysis sessions of different patients were followed to whom PAR was used as a pain reliever or antipyretic. Spent dialysate was sampled hourly and analyzed using HPLC with MS/MS and UV detection. Quantitative calculations were made on the basis of the peak areas on the chromatograms at 280 nm for uric acid (UA) and 254 nm for PAR and its metabolites (PAR-M). Peaks of UA, PAR, PAR-glucuronide, and PAR-sulphate were identified on the basis of specific mass spectra. Removal of PAR was found to be proportional to that of uric acid if intake of the drug by patient occurred half a day before dialysis. But disturbances of the UV-absorbance curves at 280 nm were observed related to rise of UA concentration in spent dialysate when PAR was taken by patients in the course of dialysis. The mechanism of such relation remains unknown. It was concluded that possible benefits and risks of treatment of uremic patients with paracetamol-containing drugs may need to be reassessed.

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Optical Online Monitoring of Uric Acid Removal during Dialysis

Cited by 20 publications

References 26 publications

Utilization of UV Absorbance for Estimation of Phosphate Elimination during Hemodiafiltration

Utilization of UV Absorbance for Estimation of Phosphate Elimination during Hemodiafiltration

Estimation of dialysis patients’ survival through combined approach of small molecule uremic markers

Paracetamol Interference in Uric Acid Levels in Uremic Patients Revealed by Monitoring Spent Dialysate

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