Online Hemodiafiltration Reduces Bisphenol A Levels

Abstract

Several uremic toxins have been identified and related to higher rates of morbidity and mortality in dialysis patients. Bisphenol A (BPA) accumulates in patients with chronic kidney disease. The aim of this study is to demonstrate the usefulness of online hemodiafiltration (OL-HDF) in reducing BPA levels. Thirty stable hemodialysis patients were selected to participate in this paired study. During three periods of 3 weeks each, patients were switched from high-flux hemodialysis (HF-HD) to OL-HDF, and back to HF-HD. BPA levels were measured in the last session of each period (pre- and post-dialysis) using ELISA and HPLC. Twenty-two patients (mean age 73 ± 14 years; 86.4% males) were included. Measurements of BPA levels by HPLC and ELISA assays showed a weak but significant correlation (r = 0.218, P = 0.012). BPA levels decreased in the OL-HDF period of hemodialysis, in contrast to the HF-HD period when they remained stable (P = 0.002). In conclusion, OL-HDF reduced BPA levels in dialysis patients.

Influence of dialysis membrane composition on plasma bisphenol A levels during online hemodiafiltration

“…The decrease of 72% in BPA levels during the first OL-HDF session when the switch membranes were BPA-free membranes is larger than expected for a protein-bound molecule. However, it is consistent with results from Quiroga et al who observed an average reduction of 45% when dialyzers with and without BPA were analyzed as a single group [ 12 ]. This is consistent with a 72% reduction with BPA-free membranes and no change with BPA-containing membranes in our study (the mean of a 72% reduction with BPA free membranes and a 1% with BPA containing membranes is a 36% reduction, in the range of the 45% observed by Quiroga et al).…”

“…Thus, BPA levels were higher in the 69 patients in the hemodialysis study (64.55±93.8 ng/ml) [ 7 ] and also in the 18 patients in the hemodialysis study that went on to be enrolled in the present study (98.96±120.75 ng/ml) than in the patients treated for longer than 6 months with OL-HDF (23.42±3.81 ng/mL). The data support the concept advanced by Quiroga et al [ 12 ], that he dialysis technique (OL-FDF vs hemodialysis) indeed results in lower BPA levels. The BPA concentration range differed in both studies, probably due to the use of a different BPA assay, to individual patient or dialysis characteristics, to different duration of the study or to the existence of limitations to BPA clearance such as continuous leakage from dialyzer membranes (in the prior studies both BPA-containing and BPA-free membranes were grouped together).…”

“…The BPA concentration range differed in both studies, probably due to the use of a different BPA assay, to individual patient or dialysis characteristics, to different duration of the study or to the existence of limitations to BPA clearance such as continuous leakage from dialyzer membranes (in the prior studies both BPA-containing and BPA-free membranes were grouped together). The short-term nature of Quiroga´s study using a heterogeneous group of dialyzers regarding the BPA contents of the dialyzer membranes did not allow the assessment of the relative contributions of the OL-HDF technique, the dialyzer composition or the follow-up time to the observed reduction in BPA levels [ 12 ]. Our data now point out that dialysis membrane composition is a key determinant of BPA levels in OL-HDF patients.…”

Critical Analysis of Human Exposure to Bisphenol A and Its Novel Implications on Renal, Cardiovascular and Hypertensive Diseases

“…After carefully studying the text, ten publications were selected 1 . Of these, only 1 quantifies the urinary BPA concentration in dialysis patients [60] and 9 in serum [15,[60][61][62][63][64][65][66][67][68].…”

Overexposure to Bisphenol A and Its Chlorinated Derivatives of Patients with End-Stage Renal Disease during Online Hemodiafiltration

“…Hence, the metabolism, tissue distribution, and elimination from the body remains unclear and no-TDI has been established for these compounds. Recent studies affirm that OL-HDF could reduce BPA blood levels in dialyzed patients [42,43]. However, the methodology used raises some questions since the number of patients was low, and some issues regarding the analytical method used.…”