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 i s 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 i s 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 i s 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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Exploratory/Developmental Grants Phase II (R33)
Project #
5R33DK071251-02
Application #
7106397
Study Section
Special Emphasis Panel (ZDK1-GRB-6 (J1))
Program Officer
Eggers, Paul Wayne
Project Start
2005-09-01
Project End
2007-08-31
Budget Start
2006-09-01
Budget End
2007-08-31
Support Year
2
Fiscal Year
2006
Total Cost
$247,578
Indirect Cost
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Meyer, Timothy W (2012) The removal of protein-bound solutes by dialysis. J Ren Nutr 22:203-6
Sirich, Tammy L; Luo, Frank J-G; Plummer, Natalie S et al. (2012) Selectively increasing the clearance of protein-bound uremic solutes. Nephrol Dial Transplant 27:1574-9
Marquez, Ilian O; Tambra, Shouieb; Luo, Frank Y et al. (2011) Contribution of residual function to removal of protein-bound solutes in hemodialysis. Clin J Am Soc Nephrol 6:290-6
Ponda, Manish P; Quan, Zhe; Melamed, Michal L et al. (2010) Methylamine clearance by haemodialysis is low. Nephrol Dial Transplant 25:1608-13
Luo, Frank J-G; Patel, Kajal P; Marquez, Ilian O et al. (2009) Effect of increasing dialyzer mass transfer area coefficient and dialysate flow on clearance of protein-bound solutes: a pilot crossover trial. Am J Kidney Dis 53:1042-9
Dinh, Diana C; Recht, Natalie S; Hostetter, Thomas H et al. (2008) Coated carbon hemoperfusion provides limited clearance of protein-bound solutes. Artif Organs 32:717-24
Pham, Nhat M; Recht, Natalie S; Hostetter, Thomas H et al. (2008) Removal of the protein-bound solutes indican and p-cresol sulfate by peritoneal dialysis. Clin J Am Soc Nephrol 3:85-90
Meyer, Timothy W; Hostetter, Thomas H (2007) Uremia. N Engl J Med 357:1316-25
Meyer, Timothy W; Peattie, John W T; Miller, Jared D et al. (2007) Increasing the clearance of protein-bound solutes by addition of a sorbent to the dialysate. J Am Soc Nephrol 18:868-74
Walther, J L; Bartlett, D W; Chew, W et al. (2006) Downloadable computer models for renal replacement therapy. Kidney Int 69:1056-63