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

Abstract

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.

Adequacy of hemodialysis in acute kidney injury: Real‐time monitoring of dialysate ultraviolet absorbance vs. blood‐based Kt/Vurea

“…The theoretical weakness of using urea clearance monitoring by UV absorbance is that the absorbance at any given wavelength is not unique for a single substance. For example, each moiety in human blood can absorb at different wavelengths, which can overlap with the absorbance spectra of other substances such as uric acid, phosphate, creatinine or medications such as paracetamol 20‐22 . Thus, choosing a wavelength based on the absorbance of urea (285 nm) would be nonspecific and UV‐Kt/Vurea may not necessarily reflect the effect of urea removal, although some reports have questioned the clinical relevance of such moieties in the determination of urea clearance.…”

“…For example, each moiety in human blood can absorb at UV vs. blood-based Kt/Vurea during RRT in AKI Hemodialysis International 2021; 25:43-49 different wavelengths, which can overlap with the absorbance spectra of other substances such as uric acid, phosphate, creatinine or medications such as paracetamol. [20][21][22] Thus, choosing a wavelength based on the absorbance of urea (285 nm) would be nonspecific and UV-Kt/ Vurea may not necessarily reflect the effect of urea removal, although some reports have questioned the clinical relevance of such moieties in the determination of urea clearance. This may be especially important in acutely ill AKI patients who receive medications that can absorb UV at or near 285 nm.…”

Routine online assessment of dialysis dose: Ionic dialysance or UV‐absorbance monitoring?

“…This is probably because the meal results in a change in the concentration of UV‐absorbing solutes in the dialysate. Fluid infusion or some drugs may also interfere with the dialysate UV‐absorbance 47‐49 …”

Electrolyte balance and voice in hemodialysis patients

“…If the colorimetric test is used for measurement of uric acid, the error can be expected in cases undergoing dialysis [3]. In addition, the concurrent use of some common drugs such as acetaminophen also result in aberrant serum uric acid result in hemodialysis patient [4].…”