Continuous renal replacement therapies, such as hemofiltration, have been used increasingly on intensive care units over the last decade as a means of managing patients with acute renal failure (1). It is clear that the regeneration of patients' ultrafiltrate (UFR), via the removal of uremic toxins, allowing it to be replaced back into the circulation, would reduce the cost burden associated with replacement solutions. This study investigated the potential use of novel, mesoporous polymer based carbons, produced by the pyrolysis and steam activation of a vinylpyridine-divinylbenzene copolymer (SCN) to remove middle molecule sized uremic toxins from UFR. Previous studies have shown that SCN has a high capacity for the adsorption of other uremic toxins including creatinine and to a lesser degree, urea (2). UFR samples were obtained from patients with acute renal failure (n=6) at an early stage in hemofiltration. The UFR samples were passed through a column containing 6g of non-oxidised SCN. Fractions were collected every 5 minutes for further analysis by Tris-Glycine SDS-PAGE gels (7.4 – 200 kD), Biogel Chromatography (>5 kD) and Tris-Tricine SDS-PAGE gels (1.5 – 26.6 kD). Both gel systems showed complete adsorption of all protein bands from the 5 minute sample with increasing break through of UFR proteins in the eluate over time. The chromatography column showed complete removal of all middle molecules from the pre-column aliquot when compared to that of the 360 minute aliquot. These results demonstrate the ability of mesoporous carbons to adsorb substances within the middle molecule rage (MW = 0.3 – 15 kD). The results presented here further support the use of activated carbons in the regeneration of UFR. The flexibility offered by these adsorbents through close control of their chemical purity, pore size distribution and surface chemistry makes them highly biocompatible and allows the targeting of specific molecules. This technology also offers potential benefits in other areas of intensive care medicine, in which specific adsorption may be of benefit, such as the removal of inflammatory molecules in sepsis.
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