Abstract Background and Aims Urea is the most commonly exploited marker of dialysis adequacy. Plenty of other uremic retention solutes with a deleterious effect on morbidity and mortality of uremic patients accumulate in ESKD patients [1]. Commonly, the uremic solutes are divided into three physicochemical types [2] with the representative markers urea, uric acid (UA),indoxyl sulfate (IS), and β2-Microglobulin (B2M). Optical monitoring of the uremic marker molecules has been proposed [3]. Despite being cumbersome as a clinical routine, direct dialysis quantification from total dialysate collection (TDC) is as the ‘gold standard’ for measuring the total amount of uremic solutes removed [4]. A robust and compact optical on-line dialysis monitoring device is a step closer to automatic assessment of removal of uremic toxins in dialysis. The aim of this study was to evaluate intradialytic on-line multicomponent Total Removed Solute (TRS) monitoring in the spent dialysate by a novel miniaturized optical sensor during hemodialysis (HD) and hemodiafiltration (HDF) with different settings. Method Ten ESKD patients (6 male and 4 female, 60.2±16.8 years) on chronic HDF were enrolled into the study (fistula N=9, graft N=1). For each patient 5 midweek dialysis sessions (length 240min, HD: N=1, Qb=200ml/min, Qd=300ml/min, 1,5m2; HDF: N=4, Qb≥300ml/min, Qd≥500ml/min, Vsubst≥15l, 1,8m2 and 2,2m2) were included. Spent dialysate from the drain was monitored on-line by a miniaturized sensor prototype (Optofluid Technologies OÜ, Estonia). For the reference, the samples from the spent dialysate drain tube of the HD machine were taken as 7, 60, 120 and 180min after the start and at the end of the session (240min). The concentrations of urea and B2M in dialysate were determined in the clinical laboratory. Concentration of IS and UA was determined utilizing the HPLC. TRS values were calculated using the tank weight and the lab or optical tank solute concentrations. t-test was used to determine significant differences between the methods (P≤0.05). Results The laboratory and optical TRS values were 489±112mM and 512±87mM for urea (R2=0.870), 4232±712µM and 4331±756µM for UA (R2=0.985), 230±47mg and 231±40mg for B2M (R2=0.906), 606±339µM and 616±321µM for IS (R2=0.969) (Fig. 1), being not statistically different for any uremic solutes. The reason for higher correlation for UA and IS is direct measurements of UA and IS by the optical sensor whereas urea and B2M are estimated indirectly. Conclusion Novel miniaturized optical sensor successfully carried out intradialytic on-line multicomponent TRS monitoring for the uremic solutes urea, UA, B2M and IS in the spent dialysate.
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