Overexposure to Bisphenol A and Its Chlorinated Derivatives of Patients with End-Stage Renal Disease during Online Hemodiafiltration.

Bacle Bacle,Pierre-Eugene Pierre-Eugene,Belmouaz Belmouaz,Ayraud-Thevenot Ayraud-Thevenot,Bauwens Bauwens,Venisse Venisse,Dupuis Dupuis,Potin Potin,Cambien Cambien,Migeot Migeot

doi:10.3390/biom9090403

Abstract

The health safety conditions governing the practice of online hemodiafiltration (OL-HDF) do not yet incorporate the risks related to the presence of endocrine disruptors such as bisphenol A (BPA). The aim of this study was to assess, for the first time, the exposure to BPA but also to its chlorinated derivatives (ClxBPA) (100 times more estrogenic than BPA) during OL-HDF. We demonstrated that BPA is transmitted by the different medical devices used in OL-HDF: ultrafilters, dialysis concentrate cartridges (and not only dialyzers, as previously described). Moreover, BPA has been found in dialysis water as well as in ultrapure dialysate and replacement fluid due to contamination of water coming from municipal network. Indeed, due to contaminations provided by both ultrafilters and water, high levels of BPA were determined in the infused replacement fluid (1033 ng.L−1) from the beginning of the session. Thus, our results demonstrate that dialysis water must be considered as an important exposure source to endocrine disruptors, especially since other micropollutants such as ClxBPA have also been detected in dialysis fluids. While assessment of the impact of this exposure remains to be done, these new findings should be taken into account to assess exposure risks in end-stage renal disease patients.

Highlights

Due to the increasing incidence of people suffering from end-stage renal disease (ESRD), more than 1 million patients around the world require renal replacement therapy [1]
bisphenol A (BPA) was detected in every dialyzer with mean levels ranging from 0.6 to 38.5 ng per dialyzer in simulating blood compartment and from 0.9 to 16.2 ng per dialyzer in dialysate compartment
Monochlorobisphenol A (MCBPA) = monochlorobisphenol A; DCBPA = dichlorobisphenol A; TCBPA = trichlorobisphenol A; tetrachlorobisphenol A (TTCBPA) =. This is the first study demonstrating that patients suffering from ESRD and treated by Online hemodiafiltration (OL-HDF) have a risk of overexposure to both BPA and to ClxBPA provided by intravenous infusion of replacement fluid

Summary

Introduction

Due to the increasing incidence of people suffering from end-stage renal disease (ESRD), more than 1 million patients around the world require renal replacement therapy [1]. Conventional HD is mainly based on the diffusive transport of solutes across a high flux membrane removing lowand middle-molecular weight uremic toxins. Biomolecules 2019, 9, 403 proposed to improve clearance of middle sized toxins (of higher molecular weight solutes) and may improve patient outcomes [4,5,6]. OL-HDF combines diffusive and convective solute transport through a high-flux permeable membrane. Fluid is removed from the patient by ultrafiltration (convection volume) and appropriate fluid balance is maintained by infusion of a replacement solution, generated online, into the patient’s blood. OL-HDF mode may differ, depending on the site of replacement fluid infusion. Post-dilution OL-HDF, corresponding to infusion of the replacement fluid downstream of the dialyzer, is the most efficient OL-HDF method regarding solute removal [3]

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