Point of Care Monitoring of Hemodialysis Patients with a Breath Ammonia Measurement Device Based on Printed Polyaniline Nanoparticle Sensors

Abstract

A device for measuring human breath ammonia was developed based on a single use, disposable, inkjet printed ammonia sensor fabricated using polyaniline nanoparticles. The device was optimized for sampling ammonia in human breath samples by addressing issues such as variations in breath sample volume, flow rate, sources of oral ammonia, temperature and humidity. The resulting system was capable of measuring ammonia in breath from 40 to 2993 ppbv (r(2 )= 0.99, n = 3) as correlated with photoacoustic laser spectroscopy and correlation in normal human breath samples yielded a slope of 0.93 and a Pearson correlation coefficient of 0.9705 (p < 0.05, n = 11). Measurement of ammonia in the breath of patients with end-stage kidney disease demonstrated its significant reduction following dialysis, while also correlating well with blood urea nitrogen (BUN) (r = 0.61, p < 0.01, n = 96). Excellent intraindividual correlations were demonstrated between breath ammonia and BUN (0.86 to 0.96), which demonstrates the possibility of using low cost point of care breath ammonia systems as a noninvasive means of monitoring kidney dysfunction and treatment.

An electrochemical sensor device for measuring blood ammonia at the point of care

“…Previous work had demonstrated that thin, inkjet-printed films of polyaniline nanoparticles were capable of very sensitive detection of ammonia in air and also in highly humidified breath samples [12]. The present device was designed to allow measurement of ammonia from the gas phase from a liquid blood sample.…”

The Measurement of Ammonia in Human Breath and its Potential in Clinical Diagnostics

“…Breath ammonia has been used to study the efficacy of haemodialysis in end stage renal failure. Several studies on the efficacy of haemodialysis have shown good correlations between BUN and breath ammonia (Gouma et al, 2010;Hibbard et al, 2013;Narasimhan et al, 2001;Neri et al, 2012).…”

“…In addition, a number of the methods contribute to pre-analytical errors due to issues such as sample transportation and handling.While a number of sensor-based approaches have been developed including quartz crystal microbalance (Becker and Cooper, 2011;Ishida et al, 2008;Ogimoto et al, 2015), chemical and optical sensors, many of these have had challenges in terms of detection limits, or operation in real humidified breath samples, which has made them unsuitable for physiological application. However, some have now demonstrated effective application in human clinical studies (Hibbard et al, 2013). Several reviews are available on ammonia measurement techniques (Davies et al, 2014;Hibbard and Killard, 2011;Spanel and Smith, 2011).…”

Selective sensing of NH 3 by Si-doped α-MoO 3 for breath analysis

“…[6] More specifically, mouth-exhaled breath NH 3 levels were identified to be around 400 -1800 ppb (mean 960) for healthy people and elevated to 820 -14700 ppb (mean 4880) for ESRD patients, [5] a trend consistent with other studies. [4,7,8] Furthermore, breath NH 3 has been proposed as indicator to removal of blood urea nitrogen (BUN) since its concentration follows the BUN kinetics during dialysis treatment. [4,5,7,8] This could enable real-time monitoring and thus an on-demand tailoring of ESRD therapy.…”