Shi Y, Tian H,Wang Y, Shen Y, Zhu Q, Ding F: Improved Dialysis Removal of Protein-Bound Uraemic Toxins with a Combined Displacement and Adsorption Technique. Blood Purification DOI 10.1159/000518065
Protein-bound uremic solutes are very inefficiently removed by standard dialytic techniques. Adding adsorption or displacement measures might enhance removal of these toxins.
In an in vitro and uremic rat model, Shi et al. analyzed the impact of an adsorptive strategy (adding bovine serum albumin [BSA] to the dialysate), a displacement strategy (infusing a fatty acid mixture to the pre-filter bold), and a combination of the two strategies on removal of protein-bound solutes (PBS; e.g., para-cresol sulfate, indoxyl sulfate, etc.).
The addition of BSA to the dialysate had a minimal effect on PBS removal. The combination of adsorptive and displacement strategies had the greatest impact on PBS removal rates. However, all of the studies were short-term in nature, so the safety and side-effects could not be evaluated. Only one type of displacement method (lipid emulsion infusion) was studied. The preliminary data are intriguing, but whether the absorptive/displacement strategies will ever reach clinical utility is highly uncertain.