Jana Jerotskaja

Optical Online Monitoring of Uric Acid Removal during Dialysis

This study estimates the total removal of uric acid (TRUA) by online UV absorbance measurements in the spent dialysate in two different dialysis centers in Estonia and Sweden. Sixteen dialysis patients were included. All dialysate was collected that gave the reference for TRUA. Two regression models were investigated: one for each patient (UV1) and one for the entire material (UV2). TRUA from the three methods was in the same order but showed a statistically significant difference when the UV2 model was built on data from both centers together. TRUA, (n = 56) was (mean ± SD, µmol): 5,854 ± 1,377 for reference, 6,117 ± 1,795 for UV1 and 5,762 ± 1,591 for UV2. Six patients were monitored 1 year after the first study session, using the same models as the previous year, still having a nonsignificant difference. The results show the possibility of estimating TRUA by using UV absorbance. The method appeared to be reliable also in long-term patient monitoring.

HPLC study of uremic fluids related to optical dialysis adequacy monitoring

PURPOSE The aim of this study was to investigate uremia-related high-performance liquid chromatography (HPLC) ultraviolet (UV) absorbance profiles of serum and spent dialysate and to study the removal of uremic retention solutes in connection with optical dialysis adequacy monitoring. METHODS 10 uremic patients were investigated using online spectrophotometry at a wavelength of 280 nm over the course of 30 hemodialysis treatments. The dialysate and blood samples were taken and analyzed simultaneously using standard biochemical methods and reversed-phase HPLC. Filters with cutoff at 3 kDa and 70 kDa were used for the pre-treatment of the serum. The chromatographic peaks were detected by a UV detector at wavelengths of 254 and 280 nm. RESULTS This study indicated that the main solute responsible for UV absorbance in the spent dialysate is a low-molecular-weight, water-soluble, non-protein-bound compound uric acid (UA). Three additional uremic retention solutes - creatinine (CR), indoxyl sulphate (IS) and hippuric acid (HA) - were identified from the HPLC profiles. The number of detected HPLC peaks was not significantly different for a serum filtered through the 3 kDa or 70 kDa cutoff filters, and was lower for the spent dialysate, indicating that the molecular weight (MW) of the main UV chromophores in the uremic fluids did not exceed 3 kDa. The reduction ratio (RR) estimated by the total area of HPLC peaks at 254 nm and 280 nm in the serum and by the online UV absorbance at 280 nm was best related to the removal of small water-soluble non-protein bound solutes like urea (UR), CR and UA. CONCLUSIONS The present study contributes new information on the removal of uremic retention solutes during hemodialysis and on the origin of the optical dialysis adequacy monitoring signal.

Optical dialysis adequacy sensor: contribution of chromophores to the ultra violet absorbance in the spent dialysate

Several on-line methods have been developed to standardize the assessment of dialysis adequacy. Earlier studies have demonstrated that on-line monitoring of total ultra violet (UV) absorbance in spent dialysate can be utilized to follow continuously a single hemodialysis session. The aim of this study was to investigate the contribution of different compounds, acting as chromophores, to the UV-absorbance in the spent dialysate in order to explain origin of the cumulative and integrated UV-absorbance measured by the optical dialysis adequacy sensor. Four uremic patients, during 12 hemodialysis treatments, were followed by the optical dialysis adequacy sensor using the wavelength of 280 mn. The dialysate samples were taken and analyzed using reversed phase high performance liquid chromatography (HPLC). The total number of detected peaks from the HPLC gradient separation profiles measured at the wavelength 280 nm for the samples collected 10 mm after the start of hemodialysis (MeanplusmnSD) was 38plusmn6. The relative contribution from the area of 10 main peaks to the total area of all detected peaks in percentage was 91.01plusmn2.52 %. The optical dialysis adequacy sensor provides continuous, on-line hemodialysis measurements and may immediately identify and alert to any deviations in the dialysis. Our study indicates that there exists a number of prevalent compounds that are the main cause of the cumulative and integrated UV- absorbance

Concentration of uric acid removed during dialysis. estimated by multi wavelength and processed ultra violet absorbance spectra

The aim of this study was to estimate the concentration of uric acid (UA) optically by using original and processed ultra violet (UV) absorbance spectras of the spent dialysate. Also the effect of using several wavelengths for estimation was examined.

A Multicenter Study of Removed Uric Acid Estimated by Ultra Violet Absorbance in the Spent Dialysate

The aim of this study was to investigate the relation between removed uric acid (UA) and measured ultra violet (UV) absorbance of the spent dialysate during dialysis.

Improved Optical Method for Measuring Concentration of Uric Acid Removed during Dialysis

The aim of this study was to compare concentration measurements of uric acid (UA) removed during dialysis. Algorithms based on ultraviolet (UV) absorbance and 1st derivate of UV-absorbance whereby single and multi-wavelength was used.

A multicentre study of an enhanced optical method for measuring concentration of uric acid removed during dialysis

The aim of this study was to compare concentration measurements of uric acid (UA) removed during dialysis by two algorithms based on UV-absorbance and the 1st derivate of UV absorbance. Ten uremic patients from Tallinn and ten from Linköping, during 30+40 haemodialysis treatments, were followed at the Departments of Dialysis and Nephrology at North-Estonian Medical Centre and at Linköping University Hospital. The dialysate samples were taken and analyzed by means of UA concentration at the chemical laboratory and with a double-beam spectrophotometer. UV absorbance and derivate of UV absorbance was transformed into UA concentration in the spent dialysate using the regression models from the calibration set of material, noted as UV-absorbance (UV_A) and the 1st derivate of UV absorbance (UV_D) method. These models were tested on validation set of material and concentrations of UA from the two methods were compared regarding mean values and SD. Mean concentration of UA were 52.7 ± 25.0 micromol/l measured at the chemical laboratory (UA_Lab), 54.9 ± 23.8 micromol/l determined by UV_A and 52.9 ± 23.0 micromol/l determined by UV_D. The results of mean concentrations were not significantly different (p ≥ 0.54). The systematic errors were -7.8 % and -3.3% and random errors were 15.8 % and 10.4 % using UV_A and UV_D respectively. The systematic and random errors were significantly different (p < 0.05) indicating that the new algorithm enables more accurate UA estimation.

A New Optical Method for Measuring Creatinine Concentration During Dialysis.

The aim of this study was to compare creatinine (Cr) concentration measurements removed during dialysis by two optical algorithms based on single wavelength and multiwavelength UV-absorbance.

Optical dialysis adequacy sensor: wavelength dependence of the ultra violet absorbance in the spent dialysate to the removed solutes

A need for dialysate-based, on-line, continuous monitoring systems for the control of dialysis efficiency and the prevention of dialysis-associated complications is arisen due to increasing number of dialysis patients and related treatment quality requirements. The aim of this study was to investigate the wavelength dependence between the the ultraviolet (UV) absorbance in the spent dialysate and the retained solutes removed during the hemodialysis in order to explain possibilities to estimate removal of the solutes by the optical dialysis adequacy sensor. Ten uremic patients, during 30 hemodialysis treatments, were followed at the Department of Dialysis and Nephrology, North-Estonian Regional Hospital. The dialysate samples were taken and analyzed with spectrophotometer to get absorbance spectra. The results confirm previous studies considering similarity for the UV-spectrum on the spent dialysate samples during a single dialysis session indicating presence of the same type of chromophores in the spent dialysate removed from the patients blood for different patients groups. At the same time the highest correlation in the spent dialysate for urea, creatinine, potassium, and phosphate was obtained at the wavelength 237 nm that is a new finding compared to earlier results. The highest correlation between the UV-absorbance and uric acid in the spent dialysate was obtained at the wavelength 294 nm. Presence of at least two different wavelength ranges may add selectivity for monitoring several compounds. Our study indicates that the technique has a potential to estimate the removal of retained substances.

Accurate On-line Estimation of Delivered Dialysis Dose by Dialysis Adequacy Monitor (DIAMON)

The aim of this study was to compare equilibrated urea Kt/V (eKt/V) from the slope of the logarithmic online UV-absorbance measurements measured by the Dialysis Adequacy Monitor (DIAMON), by eKt/V obtained from a new algorithm that can be implemented into the DIAMON prototype. As the reference the urea eKt/V was utilized obtained from the blood samples according to the rate adjustment method. The mean value of equilibrated Kt/V obtained with UV-absorbance (eKt/Va) was 1.06 ± 0.21, using the new algorithm (eKt/Vn) was 1.09 ± 0.18, and eKt/V from blood-urea (eKt/Vb) 1.09 ± 0.20 (N = 21). The mean values of eKt/V were not statistically different comparing different methods. However, both the systematic and the random error were diminished by the new algorithm. The systematic error was decreased from 2.19% to 0.312%, and the random error was decreased from 14.37% to 7.30% using the new algorithm. In summary, the DIAMON prototype can accurately and on-line estimate the dialysis dose.