Abstract
Protein-binding uremic toxins such as indoxyl sulfate (IS) and pentosidine (PEN) cannot be removed efficiently by hemodialysis (HD) and therefore, these toxins accumulate in HD patients. In the present study, removability of protein-binding uremic toxins was compared between cellulose triacetate dialyzer (FB-UH) and polysulphone dialyzer (APS-MD) in 14 HD patients. Patients were treated with FB-UH and APS-MD in a crossover manner under the same condition for three months each, and plasma levels of IS and PEN were measured at the end of each treatment. Although the removal rate of small molecular materials did not differ between the two dialyzers, β2-microglobulin was removed more efficiently with FB-UH than with APS-MD. The removal rates of IS and PEN were greater with FB-UH (54±3% and 20±5%, respectively) than with APS-MD (34±3% and 11±4%, respectively). The leakage of albumin into dialysate effluent was also greater with FB-UH compared with APS-MD (2.6±1.2 g vs 1.3±0.2 g, p<0.05). Using FB-UH but not APS-MD, the removal rate of PEN was correlated with the leakage of albumin into dialysate effluent (r=0.56). In conclusion, FB-UH was superior to APS-MD with regard to removing protein-binding uremic toxins via greater leakage of albumin into dialysate effluent.
