Proteomic Investigations into Hemodialysis Therapy

Abstract

The retention of a number of solutes that may cause adverse biochemical/biological effects, called uremic toxins, characterizes uremic syndrome. Uremia therapy is based on renal replacement therapy, hemodialysis being the most commonly used modality. The membrane contained in the hemodialyzer represents the ultimate determinant of the success and quality of hemodialysis therapy. Membrane’s performance can be evaluated in terms of removal efficiency for unwanted solutes and excess fluid, and minimization of negative interactions between the membrane material and blood components that define the membrane’s bio(in)compatibility. Given the high concentration of plasma proteins and the complexity of structural functional relationships of this class of molecules, the performance of a membrane is highly influenced by its interaction with the plasma protein repertoire. Proteomic investigations have been increasingly applied to describe the protein uremic milieu, to compare the blood purification efficiency of different dialyzer membranes or different extracorporeal techniques, and to evaluate the adsorption of plasma proteins onto hemodialysis membranes. In this article, we aim to highlight investigations in the hemodialysis setting making use of recent developments in proteomic technologies. Examples are presented of why proteomics may be helpful to nephrology and may possibly affect future directions in renal research.

Proteomic Characterization of a New asymmetric Cellulose Triacetate Membrane for Hemodialysis

“…Proteomic application may provide a valid support for manufacturers and dialysis technologists when it comes to implementing the membrane biomaterials used for fabrication of HD membranes . Proteomic techniques allow one to evaluate the type and amount of all proteins and peptides removed from blood and recovered in spent dialysis fluid during the extracorporeal procedure .…”

Concurrent Hemoperfusion and Hemodialysis in Patients with Acute Pesticide Intoxication

“…The safety of dialysis depends on the biocompatibility of the dialyzer material, which is the sum of specific interactions between blood and artificial materials of the extracorporeal circuit [21,22] . Activation of the complement cascade, stimulation of cytokine production, and activation of the coagulation cascade may be disadvantageous for sequential or concurrent HP and HD [23] .…”

Examining hemodialyzer membrane performance using proteomic technologies

“…Notably, interaction with surface-adsorbed proteins may trigger several biologic pathways including the complement system, the coagulation cascade, and cellular mechanisms. 9 So, protein adsorption mainly governs the bio(in)compatibility of a membrane. Bioincompatibility of HD membranes is thought to play a role in both acute and chronic complications associated with extracorporeal blood purification, 10 and represents a major challenge to improving the quality of dialysis therapy.…”

“…Application of proteomic techniques has enabled us to overcome this limitation. Proteomics is being increasingly used and represents a powerful tool affording fundamental and advanced molecular knowledge in the field of uremia and related substitutive therapy, 9 , 13 – 16 powered in great part by the improvement in proteomic technology. Proteomics can be successfully applied to identification, as well as relative and absolute quantification, of proteins in complex samples such as dialysis fluid or fluid desorbed from the dialysis membrane.…”