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Is Fluorescence Valid to Monitor Removal of Protein Bound Uremic Solutes in Dialysis?
Tallinn University of Technology, Estonia.
North Estonia Medical Centre, Estonia.
Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Tallinn University of Technology, Estonia.
Tallinn University of Technology, Estonia.
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, e0156541Article in journal (Refereed) Published
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Abstract [en]

The aim of this study was to evaluate the contribution and removal dynamics of the main fluorophores during dialysis by analyzing the spent dialysate samples to prove the hypothesis whether the fluorescence of spent dialysate can be utilized for monitoring removal of any of the protein bound uremic solute. A high performance liquid chromatography system was used to separate and quantify fluorophoric solutes in the spent dialysate sampled at the start and the end of 99 dialysis sessions, including 57 hemodialysis and 42 hemodiafiltration treatments. Fluorescence was acquired at excitation 280 nm and emission 360 nm. The main fluorophores found in samples were identified as indole derivatives: tryptophan, indoxyl glucuronide, indoxyl sulfate, 5-hydroxy-indoleacetic acid, indoleacetyl glutamine, and indoleacetic acid. The highest contribution (35 +/- 11%) was found to arise from indoxyl sulfate. Strong correlation between contribution values at the start and end of dialysis (R-2 = 0.90) indicated to the stable contribution during the course of the dialysis. The reduction ratio of indoxyl sulfate was very close to the decrease of the total fluorescence signal of the spent dialysate (49 +/- 14% vs 51 +/- 13% respectively, P = 0.30, N = 99) and there was strong correlation between these reduction ratio values (R-2 = 0.86). On-line fluorescence measurements were carried out to illustrate the technological possibility for real-time dialysis fluorescence monitoring reflecting the removal of the main fluorophores from blood into spent dialysate. In summary, since a predominant part of the fluorescence signal at excitation 280 nm and emission 360 nm in the spent dialysate originates from protein bound derivatives of indoles, metabolites of tryptophan and indole, the fluorescence signal at this wavelength region has high potential to be utilized for monitoring the removal of slowly dialyzed uremic toxin indoxyl sulfate.

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PUBLIC LIBRARY SCIENCE , 2016. Vol. 11, no 5, e0156541
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Analytical Chemistry
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URN: urn:nbn:se:liu:diva-129672DOI: 10.1371/journal.pone.0156541ISI: 000376882500155PubMedID: 27228162OAI: oai:DiVA.org:liu-129672DiVA: diva2:943127
Note

Funding Agencies|County Council of Ostergotland, Sweden; Estonian Science Foundation [8621]; Estonian targeted financed project [SF0140027s07]; Estonian Ministry of Education and Research [IUT 19-2]; European Union through the European Regional Development Fund

Available from: 2016-06-27 Created: 2016-06-23 Last updated: 2017-11-28

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Uhlin, Fredrik

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