Removal of Protein-Bound Solutes by Dialysis

Summary

Principal Investigator: Timothy Meyer
Abstract: Solutes that bind to plasma proteins are poorly cleared by conventional hemodialysis. Accumulation of such solutes may contribute to residual uremic illness in dialysis patients. The proposed studies will measure protein-bound solute clearances and test means for reducing protein-bound solute levels in dialysis patients. The first aim is to reduce protein-bound solute levels in patients on conventional hemodialysis. The proposed studies will test whether levels of protein-bound solutes can be reduced without any increase in dialysis time by raising the dialyzer mass transfer area coefficient and dialysate flow. The second aim is to determine how different dialysis prescriptions effect protein-bound solute levels in patients on daily nocturnal hemodialysis (DNHD). The proposed studies will test the prediction that the clearance of protein-bound solutes during DNHD can be varied independent of urea clearance, and that it can be increased by increasing dialysate flow. The third aim is to measure protein-bound solute levels in subjects enrolled in the Frequent Hemodialysis Network (FHN) trial. The proposed ancillary study to the FHN will provide a unique opportunity to relate protein-bound solute levels to other chemical parameters and indices of well-being in a large group of hemodialysis patients.
Funding Period: 2005-09-01 - 2010-08-31
more information: NIH RePORT

Top Publications

  1. pmc Selectively increasing the clearance of protein-bound uremic solutes
    Tammy L Sirich
    Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA, USA
    Nephrol Dial Transplant 27:1574-9. 2012
  2. ncbi The removal of protein-bound solutes by dialysis
    Timothy W Meyer
    Department of Medicine Nephrology, VA Palo Alto HCS, Palo Alto, California 94303, USA
    J Ren Nutr 22:203-6. 2012
  3. pmc Contribution of residual function to removal of protein-bound solutes in hemodialysis
    Ilian O Marquez
    Department of Medicine, VA Palo Alto HCS and Stanford University, 3801 Miranda Avenue, Palo Alto, CA 94303, USA
    Clin J Am Soc Nephrol 6:290-6. 2011
  4. pmc Methylamine clearance by haemodialysis is low
    Manish P Ponda
    Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Room 615, Ullmann Building, 1300 Morris Park Ave, Bronx, NY 10461, USA
    Nephrol Dial Transplant 25:1608-13. 2010
  5. ncbi Effect of increasing dialyzer mass transfer area coefficient and dialysate flow on clearance of protein-bound solutes: a pilot crossover trial
    Frank J G Luo
    Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA 94303, USA
    Am J Kidney Dis 53:1042-9. 2009
  6. ncbi Coated carbon hemoperfusion provides limited clearance of protein-bound solutes
    Diana C Dinh
    Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA, USA
    Artif Organs 32:717-24. 2008
  7. pmc Removal of the protein-bound solutes indican and p-cresol sulfate by peritoneal dialysis
    Nhat M Pham
    Department of Medicine, VA Palo Alto Health Care System, and Stanford University, Palo Alto, California, USA
    Clin J Am Soc Nephrol 3:85-90. 2008
  8. ncbi Uremia
    Timothy W Meyer
    Stanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
    N Engl J Med 357:1316-25. 2007
  9. ncbi Increasing the clearance of protein-bound solutes by addition of a sorbent to the dialysate
    Timothy W Meyer
    Department of Medicine, VA Palo Alto HCS, Palo Alto, CA 94303, USA
    J Am Soc Nephrol 18:868-74. 2007
  10. ncbi Downloadable computer models for renal replacement therapy
    J L Walther
    Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, California 94304, USA
    Kidney Int 69:1056-63. 2006

Scientific Experts

  • Timothy Meyer
  • Tammy L Sirich
  • Frank J G Luo
  • Thomas H Hostetter
  • Ilian O Marquez
  • Manish P Ponda
  • Nhat M Pham
  • Diana C Dinh
  • Natalie S Recht
  • J L Walther
  • You Li
  • Shouieb Tambra
  • Natalie S Plummer
  • Amanda Raff
  • Michal L Melamed
  • Zhe Quan
  • W Chew
  • T H Hostetter
  • D W Bartlett
  • C R Robertson

Detail Information

Publications10

  1. pmc Selectively increasing the clearance of protein-bound uremic solutes
    Tammy L Sirich
    Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA, USA
    Nephrol Dial Transplant 27:1574-9. 2012
    ..This study assessed whether bound solute clearances can be increased while maintaining urea clearance constant during the extended hours of nocturnal dialysis...
  2. ncbi The removal of protein-bound solutes by dialysis
    Timothy W Meyer
    Department of Medicine Nephrology, VA Palo Alto HCS, Palo Alto, California 94303, USA
    J Ren Nutr 22:203-6. 2012
    ..A trial testing whether reducing bound solute levels clinically benefits dialysis patients is required to determine whether these measures should be adopted in routine clinical practice...
  3. pmc Contribution of residual function to removal of protein-bound solutes in hemodialysis
    Ilian O Marquez
    Department of Medicine, VA Palo Alto HCS and Stanford University, 3801 Miranda Avenue, Palo Alto, CA 94303, USA
    Clin J Am Soc Nephrol 6:290-6. 2011
    ..This study evaluated the contribution of residual function to the removal of solutes for which protein binding limits clearance by hemdialysis...
  4. pmc Methylamine clearance by haemodialysis is low
    Manish P Ponda
    Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Room 615, Ullmann Building, 1300 Morris Park Ave, Bronx, NY 10461, USA
    Nephrol Dial Transplant 25:1608-13. 2010
    ..However, urea is relatively non-toxic and has properties distinct from large classes of other retained solutes. In particular, intracellularly sequestered solutes are likely to behave differently than urea...
  5. ncbi Effect of increasing dialyzer mass transfer area coefficient and dialysate flow on clearance of protein-bound solutes: a pilot crossover trial
    Frank J G Luo
    Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA 94303, USA
    Am J Kidney Dis 53:1042-9. 2009
    ....
  6. ncbi Coated carbon hemoperfusion provides limited clearance of protein-bound solutes
    Diana C Dinh
    Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, CA, USA
    Artif Organs 32:717-24. 2008
    ..These results indicate that hemoperfusion over coated granular carbon provides limited clearance of protein-bound solutes...
  7. pmc Removal of the protein-bound solutes indican and p-cresol sulfate by peritoneal dialysis
    Nhat M Pham
    Department of Medicine, VA Palo Alto Health Care System, and Stanford University, Palo Alto, California, USA
    Clin J Am Soc Nephrol 3:85-90. 2008
    ..Protein-bound solutes are poorly cleared by peritoneal dialysis. We examined the hypothesis that plasma concentrations of bound solutes would therefore rise as residual renal function is lost...
  8. ncbi Uremia
    Timothy W Meyer
    Stanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
    N Engl J Med 357:1316-25. 2007
  9. ncbi Increasing the clearance of protein-bound solutes by addition of a sorbent to the dialysate
    Timothy W Meyer
    Department of Medicine, VA Palo Alto HCS, Palo Alto, CA 94303, USA
    J Am Soc Nephrol 18:868-74. 2007
    ..These results suggest that as an adjunct to conventional hemodialysis, addition of sorbents to the dialysate could increase the clearance of protein-bound solutes without greatly altering the clearance of unbound solutes...
  10. ncbi Downloadable computer models for renal replacement therapy
    J L Walther
    Department of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, California 94304, USA
    Kidney Int 69:1056-63. 2006
    ..The program calculates the time-averaged solute concentration and provides a graphic display of the solute concentration profile through a week-long interval...