Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients
Tryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS)...
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MDPI AG
2020-02-01
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| Series: | International Journal of Molecular Sciences |
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| Online Access: | https://www.mdpi.com/1422-0067/21/4/1522 |
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| author | Joosep Paats Annika Adoberg Jürgen Arund Annemieke Dhondt Anders Fernström Ivo Fridolin Griet Glorieux Liisi Leis Merike Luman Emilio Gonzalez-Parra Vanessa Maria Perez-Gomez Kristjan Pilt Didier Sanchez-Ospina Mårten Segelmark Fredrik Uhlin Alberto Arduan Ortiz |
| author_facet | Joosep Paats Annika Adoberg Jürgen Arund Annemieke Dhondt Anders Fernström Ivo Fridolin Griet Glorieux Liisi Leis Merike Luman Emilio Gonzalez-Parra Vanessa Maria Perez-Gomez Kristjan Pilt Didier Sanchez-Ospina Mårten Segelmark Fredrik Uhlin Alberto Arduan Ortiz |
| author_sort | Joosep Paats |
| collection | DOAJ |
| description | Tryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS) and indole acetic acid (IAA), in ESKD patients in different dialysis treatment settings. This prospective multicentre study in four European dialysis centres enrolled 78 patients with ESKD. Blood and spent dialysate samples obtained during dialysis were analysed with high-performance liquid chromatography to assess uremic solutes, their reduction ratio (RR) and total removed solute (TRS). Mean free serum tryptophan and IS concentrations increased, and concentration of IAA decreased over pre-dialysis levels (67%, 49%, −0.8%, respectively) during the first hour of dialysis. While mean serum total urea, IS and IAA concentrations decreased during dialysis (−72%, −39%, −43%, respectively), serum tryptophan levels increased, resulting in negative RR (−8%) towards the end of the dialysis session (<i>p</i> < 0.001), despite remarkable Trp losses in dialysate. RR and TRS values based on serum (total, free) and dialysate solute concentrations were lower for conventional low-flux dialysis (<i>p</i> < 0.001). High-efficiency haemodiafiltration resulted in 80% higher Trp losses than conventional low-flux dialysis, despite similar neutral Trp RR values. In conclusion, serum Trp concentrations and RR behave differently from uremic solutes IS, IAA and urea and Trp RR did not reflect dialysis Trp losses. Conventional low-flux dialysis may not adequately clear Trp-related uremic toxins while high efficiency haemodiafiltration increased Trp losses. |
| first_indexed | 2024-04-13T04:19:09Z |
| format | Article |
| id | doaj.art-1554936fe3bb425c9da2975ecc8fe0c1 |
| institution | Directory Open Access Journal |
| issn | 1422-0067 |
| language | English |
| last_indexed | 2024-04-13T04:19:09Z |
| publishDate | 2020-02-01 |
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| record_format | Article |
| series | International Journal of Molecular Sciences |
| spelling | doaj.art-1554936fe3bb425c9da2975ecc8fe0c12022-12-22T03:02:51ZengMDPI AGInternational Journal of Molecular Sciences1422-00672020-02-01214152210.3390/ijms21041522ijms21041522Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD PatientsJoosep Paats0Annika Adoberg1Jürgen Arund2Annemieke Dhondt3Anders Fernström4Ivo Fridolin5Griet Glorieux6Liisi Leis7Merike Luman8Emilio Gonzalez-Parra9Vanessa Maria Perez-Gomez10Kristjan Pilt11Didier Sanchez-Ospina12Mårten Segelmark13Fredrik Uhlin14Alberto Arduan Ortiz15Department of Health Technologies, Tallinn University of Technology, 19086 Tallinn, EstoniaCentre of Nephrology, North Estonia Medical Centre, 13419 Tallinn, EstoniaDepartment of Health Technologies, Tallinn University of Technology, 19086 Tallinn, EstoniaNephrology Division, Ghent University Hospital, 9000 Ghent, BelgiumDepartment of Nephrology and Department of Medicine and Health Science, Linköping University, 58185 Linköping, SwedenDepartment of Health Technologies, Tallinn University of Technology, 19086 Tallinn, EstoniaNephrology Division, Ghent University Hospital, 9000 Ghent, BelgiumCentre of Nephrology, North Estonia Medical Centre, 13419 Tallinn, EstoniaDepartment of Health Technologies, Tallinn University of Technology, 19086 Tallinn, EstoniaFundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, SpainFundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, SpainDepartment of Health Technologies, Tallinn University of Technology, 19086 Tallinn, EstoniaFundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, SpainDepartment of Nephrology and Department of Medicine and Health Science, Linköping University, 58185 Linköping, SwedenDepartment of Health Technologies, Tallinn University of Technology, 19086 Tallinn, EstoniaFundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, SpainTryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS) and indole acetic acid (IAA), in ESKD patients in different dialysis treatment settings. This prospective multicentre study in four European dialysis centres enrolled 78 patients with ESKD. Blood and spent dialysate samples obtained during dialysis were analysed with high-performance liquid chromatography to assess uremic solutes, their reduction ratio (RR) and total removed solute (TRS). Mean free serum tryptophan and IS concentrations increased, and concentration of IAA decreased over pre-dialysis levels (67%, 49%, −0.8%, respectively) during the first hour of dialysis. While mean serum total urea, IS and IAA concentrations decreased during dialysis (−72%, −39%, −43%, respectively), serum tryptophan levels increased, resulting in negative RR (−8%) towards the end of the dialysis session (<i>p</i> < 0.001), despite remarkable Trp losses in dialysate. RR and TRS values based on serum (total, free) and dialysate solute concentrations were lower for conventional low-flux dialysis (<i>p</i> < 0.001). High-efficiency haemodiafiltration resulted in 80% higher Trp losses than conventional low-flux dialysis, despite similar neutral Trp RR values. In conclusion, serum Trp concentrations and RR behave differently from uremic solutes IS, IAA and urea and Trp RR did not reflect dialysis Trp losses. Conventional low-flux dialysis may not adequately clear Trp-related uremic toxins while high efficiency haemodiafiltration increased Trp losses.https://www.mdpi.com/1422-0067/21/4/1522uremic toxinstryptophantryptophan-derived uremic toxinsindoxyl sulfateindole-3 acetic acidend-stage kidney diseasechronic kidney diseasehaemodialysishaemodiafiltration |
| spellingShingle | Joosep Paats Annika Adoberg Jürgen Arund Annemieke Dhondt Anders Fernström Ivo Fridolin Griet Glorieux Liisi Leis Merike Luman Emilio Gonzalez-Parra Vanessa Maria Perez-Gomez Kristjan Pilt Didier Sanchez-Ospina Mårten Segelmark Fredrik Uhlin Alberto Arduan Ortiz Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients International Journal of Molecular Sciences uremic toxins tryptophan tryptophan-derived uremic toxins indoxyl sulfate indole-3 acetic acid end-stage kidney disease chronic kidney disease haemodialysis haemodiafiltration |
| title | Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients |
| title_full | Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients |
| title_fullStr | Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients |
| title_full_unstemmed | Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients |
| title_short | Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients |
| title_sort | serum levels and removal by haemodialysis and haemodiafiltration of tryptophan derived uremic toxins in eskd patients |
| topic | uremic toxins tryptophan tryptophan-derived uremic toxins indoxyl sulfate indole-3 acetic acid end-stage kidney disease chronic kidney disease haemodialysis haemodiafiltration |
| url | https://www.mdpi.com/1422-0067/21/4/1522 |
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