Seolhyun Lee1,2, Tammy L Sirich3,2, Ignacio J Blanco3, Natalie S Plummer3,2, Timothy W Meyer3,2. 1. The Department of Medicine, Stanford University, Palo Alto, California seolhyun@stanford.edu. 2. The Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California. 3. The Department of Medicine, Stanford University, Palo Alto, California.
Abstract
BACKGROUND AND OBJECTIVES: Adsorption of uremic solutes to activated carbon provides a potential means to limit dialysate volumes required for new dialysis systems. The ability of activated carbon to take up uremic solutes has, however, not been adequately assessed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Graded volumes of waste dialysate collected from clinical hemodialysis treatments were passed through activated carbon blocks. Metabolomic analysis assessed the adsorption by activated carbon of a wide range of uremic solutes. Additional experiments tested the ability of the activated carbon to increase the clearance of selected solutes at low dialysate flow rates. RESULTS: Activated carbon initially adsorbed the majority, but not all, of 264 uremic solutes examined. Solute adsorption fell, however, as increasing volumes of dialysate were processed. Moreover, activated carbon added some uremic solutes to the dialysate, including methylguanidine. Activated carbon was particularly effective in adsorbing uremic solutes that bind to plasma proteins. In vitro dialysis experiments showed that introduction of activated carbon into the dialysate stream increased the clearance of the protein-bound solutes indoxyl sulfate and p-cresol sulfate by 77%±12% (mean±SD) and 73%±12%, respectively, at a dialysate flow rate of 200 ml/min, but had a much lesser effect on the clearance of the unbound solute phenylacetylglutamine. CONCLUSIONS: Activated carbon adsorbs many but not all uremic solutes. Introduction of activated carbon into the dialysate stream increased the clearance of those solutes that it does adsorb.
BACKGROUND AND OBJECTIVES: Adsorption of uremic solutes to activated carbon provides a potential means to limit dialysate volumes required for new dialysis systems. The ability of activated carbon to take up uremic solutes has, however, not been adequately assessed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Graded volumes of waste dialysate collected from clinical hemodialysis treatments were passed through activated carbon blocks. Metabolomic analysis assessed the adsorption by activated carbon of a wide range of uremic solutes. Additional experiments tested the ability of the activated carbon to increase the clearance of selected solutes at low dialysate flow rates. RESULTS: Activated carbon initially adsorbed the majority, but not all, of 264 uremic solutes examined. Solute adsorption fell, however, as increasing volumes of dialysate were processed. Moreover, activated carbon added some uremic solutes to the dialysate, including methylguanidine. Activated carbon was particularly effective in adsorbing uremic solutes that bind to plasma proteins. In vitro dialysis experiments showed that introduction of activated carbon into the dialysate stream increased the clearance of the protein-bound solutes indoxyl sulfate and p-cresol sulfate by 77%±12% (mean±SD) and 73%±12%, respectively, at a dialysate flow rate of 200 ml/min, but had a much lesser effect on the clearance of the unbound solute phenylacetylglutamine. CONCLUSIONS: Activated carbon adsorbs many but not all uremic solutes. Introduction of activated carbon into the dialysate stream increased the clearance of those solutes that it does adsorb.
Authors: Timothy W Meyer; John W T Peattie; Jared D Miller; Diana C Dinh; Natalie S Recht; Jason L Walther; Thomas H Hostetter Journal: J Am Soc Nephrol Date: 2007-01-24 Impact factor: 10.121
Authors: Raymond Vanholder; Eva Schepers; Anneleen Pletinck; Evi V Nagler; Griet Glorieux Journal: J Am Soc Nephrol Date: 2014-05-08 Impact factor: 10.121
Authors: Aleksey Etinger; Sumit R Kumar; William Ackley; Leland Soiefer; Jonathan Chun; Prabjhot Singh; Eric Grossman; Albert Matalon; Robert S Holzman; Bjorn Meijers; Jerome Lowenstein Journal: PLoS One Date: 2018-02-22 Impact factor: 3.240