Optical Method and Biochemical Source for the Assessment of the Middle-Molecule Uremic Toxin β2-Microglobulin in Spent Dialysate

Paats, Joosep; Adoberg, Annika; Arund, Jürgen; Fridolin, Ivo; Lauri, Kai; Leis, Liisi; Luman, Merike; Tanner, Risto

doi:10.3390/toxins13040255

Cited by 7 publications

(7 citation statements)

References 63 publications

(81 reference statements)

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“…A multiwavelength fluorescence approach can yield a high correlation of up to 0.958 between laboratory and optically estimated β2M concentrations in spent dialysate. The main contributors to the optical signal of the middle molecule (MM) fraction were provisionally identified as tryptophan (Trp) in small peptides and proteins and AGEs [90]. Figure 6b visualize the good agreement between β2M concentrations analyzed in laboratory vs. those predicted by an optical model during 29 four-hour HDF sessions.…”

Section: Optical Intradialytic Monitoring Of Middle Molecules' Removalmentioning

confidence: 86%

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Optical Online Monitoring of Uremic Toxins beyond Urea

Uhlin,

Fridolin

2023

Updates on Hemodialysis

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This chapter presents origin and physical basis of the optical method for traditional haemodialysis (HD) dose assessment, accepted as a valid bloodless, robust, automatic, in situ and online monitoring technology in clinical praxis. Dialysis dose Kt/V, total removed urea (TRU) and the nutrition parameters PCR, nPCR estimation from ultraviolet (UV) absorbance in the spent dialysate is explained. Since urea, a small water-soluble uremic solute and a surrogate marker for the efficiency of dialysis treatment to clear the blood of toxins and metabolic end products, is not representative for all retained uremic toxins removed with the modern dialysis care, new developments of optical online monitoring of uremic toxins, beyond urea, are discussed. Optical intradialytic monitoring of small-, middle- and protein-bound molecules’ removal, exemplified by marker molecules uric acid, beta-2 microglobulin and indoxyl sulphate, is described. A new concept and sensor technology for multi-component uremic toxins’ intradialytic optical monitoring of spent dialysate with some clinical examples are introduced. Drug interference studies during the optical dialysis monitoring and future directions in optical monitoring are included. Offered benefits will be more patient-centred, integrated and cost-efficient care, as feedback for clinicians helps to improve and personalize the treatment quality, minimizing costly adverse effects.

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Section: Optical Intradialytic Monitoring Of Middle Molecules' Removalmentioning

confidence: 86%

“…Several in vitro and online studies towards optical multi-component uremic toxins' monitoring have been published by our group during the last 10 years [9,[95][96][97][98] [90]].…”

Section: Multi-component Uremic Toxins' Intradialytic Optical Monitor...mentioning

confidence: 99%

Optical Online Monitoring of Uremic Toxins beyond Urea

Uhlin,

Fridolin

2023

Updates on Hemodialysis

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“…For example, body composition (e.g. fluid load, lean mass and fat), respiratory rate and haemoconcentration can be estimated by bioimpedance spectroscopy 121 , whereas optical 122 , ion-selective 123 and electrical conductivity sensors 124 can be used to monitor the composition of blood and dialysate.…”

Section: Discussionmentioning

confidence: 99%

Portable, wearable and implantable artificial kidney systems: needs, opportunities and challenges

Ramada,

de Vries,

Vollenbroek

et al. 2023

Nat Rev Nephrol

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Haemodialysis is life sustaining but expensive, provides limited removal of uraemic solutes, is associated with poor patient quality of life and has a large carbon footprint. Innovative dialysis technologies such as portable, wearable and implantable artificial kidney systems are being developed with the aim of addressing these issues and improving patient care. An important challenge for these technologies is the need for continuous regeneration of a small volume of dialysate. Dialysate recycling systems based on sorbents have great potential for such regeneration. Novel dialysis membranes composed of polymeric or inorganic materials are being developed to improve the removal of a broad range of uraemic toxins, with low levels of membrane fouling compared with currently available synthetic membranes. To achieve more complete therapy and provide important biological functions, these novel membranes could be combined with bioartificial kidneys, which consist of artificial membranes combined with kidney cells. Implementation of these systems will require robust cell sourcing; cell culture facilities annexed to dialysis centres; large-scale, low-cost production; and quality control measures. These challenges are not trivial, and global initiatives involving all relevant stakeholders, including academics, industrialists, medical professionals and patients with kidney disease, are required to achieve important technological breakthroughs.

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“…Blood and spent dialysate samples were collected during each dialysis session [ 28 ]. Serum and spent dialysate concentrations of uraemic toxins were determined in clinical or analytical laboratories as described earlier [ 28 , 29 ]. In short, urea, UA and β2M were assessed in clinical biochemistry labs and IS and UA were assessed by high-performance liquid chromatography (HPLC), as shown in Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The TAC of uraemic retention solutes in serum over dialysis sessions was calculated by the following equation [ 29 ], where the denominator is a simplified single-pool Kt/V:…”

Section: Methodsmentioning

confidence: 99%

Time-averaged concentration estimation of uraemic toxins with different removal kinetics: a novel approach based on intradialytic spent dialysate measurements

Paats

Adoberg

Arund

et al. 2022

Clinical Kidney Journal

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Background Kt/Vurea is the most used marker to estimate dialysis adequacy; however, it does not reflect the removal of many other uremic toxins, and a new approach is needed. We have assessed the feasibility of estimating intradialytic serum time-averaged concentration (TAC) of various uremic toxins from their spent dialysate concentrations that can be estimated non-invasively online with optical methods. Methods Serum and spent dialysate levels and total removed solute (TRS) of urea, uric acid (UA), indoxyl sulfate (IS) and β2-microglobulin (β2M) were evaluated with laboratory methods during 312 hemodialysis sessions in 78 patients with 4 different dialysis treatment settings. TAC was calculated from serum concentrations and evaluated from TRS and logarithmic mean concentrations of spent dialysate (Mln D). Results Mean intradialytic serum TAC values of urea, UA, β2M and IS were 10.4±3.8 mmol/L, 191.6±48.1 µmol/L, 13.3±4.3 mg/L and 82.9±43.3 µmol/L, respectively. These serum TAC values were similar and highly correlated to those estimated from TRS: 10.5±3.6 mmol/L (R2 = 0.92), 191.5±42.8 µmol/L (R2 = 0.79), 13.0±3.2 mg/L (R2 = 0.59), and 82.7±40.0 µmol/L (R2 = 0.85) and from Mln D 10.7±3.7 mmol/L (R2 = 0.92), 191.6±43.8 µmol/L (R2 = 0.80), 12.9±3.2 mg/L (R2 = 0.63), and 82.2±38.6 µmol/L (R2 = 0.84), respectively. Conclusions Intradialytic serum TAC of different uremic toxins can be estimated non-invasively from their concentration in spent dialysate. This sets the stage for TAC estimation from online optical monitoring of spent dialysate concentrations of diverse solutes and for further optimization of estimation models for each uremic toxin.

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Optical Method and Biochemical Source for the Assessment of the Middle-Molecule Uremic Toxin β2-Microglobulin in Spent Dialysate

Cited by 7 publications

References 63 publications

Optical Online Monitoring of Uremic Toxins beyond Urea

Optical Online Monitoring of Uremic Toxins beyond Urea

Portable, wearable and implantable artificial kidney systems: needs, opportunities and challenges

Time-averaged concentration estimation of uraemic toxins with different removal kinetics: a novel approach based on intradialytic spent dialysate measurements

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