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Khokhar M. Non-invasive detection of renal disease biomarkers through breath analysis. J Breath Res 2024; 18:024001. [PMID: 38099568 DOI: 10.1088/1752-7163/ad15fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
Breath biomarkers are substances found in exhaled breath that can be used for non-invasive diagnosis and monitoring of medical conditions, including kidney disease. Detection techniques include mass spectrometry (MS), gas chromatography (GC), and electrochemical sensors. Biosensors, such as GC-MS or electronic nose (e-nose) devices, can be used to detect volatile organic compounds (VOCs) in exhaled breath associated with metabolic changes in the body, including the kidneys. E-nose devices could provide an early indication of potential kidney problems through the detection of VOCs associated with kidney dysfunction. This review discusses the sources of breath biomarkers for monitoring renal disease during dialysis and different biosensor approaches for detecting exhaled breath biomarkers. The future of using various types of biosensor-based real-time breathing diagnosis for renal failure is also discussed.
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Affiliation(s)
- Manoj Khokhar
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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2
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Davenport A. Why is Intradialytic Hypotension the Commonest Complication of Outpatient Dialysis Treatments? Kidney Int Rep 2023; 8:405-418. [PMID: 36938081 PMCID: PMC10014354 DOI: 10.1016/j.ekir.2022.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Intradialytic hypotension (IDH) is the most frequent complication of hemodialysis (HD) treatments with a frequency of 10% to 12% for patients with chronic kidney disease attending for outpatient treatments and is associated with both temporary ischemic stress to vital organs, including the heart and brain, and increased patient mortality. Although there have been many different definitions of IDH over the years, an absolute nadir systolic blood pressure (SBP) has the strongest association with patient outcomes. The unifying pathophysiology is one of reduced effective blood volume, resulting in lower plasma tonicity, and if this cannot be adequately compensated for by activation of neurohumeral systems, then arteriolar tone and blood pressure fall. The risk factors for developing IDH are numerous, ranging from patient-related factors, including age and comorbidity with reduced cardiac reserve, to patient compliance with dietary and lifestyle advice, to reactions with the extracorporeal circuit and medications, choice of dialysate composition and temperature, setting of postdialysis target weight, ultrafiltration rate, and profiling. Advances in dialysis machine technology by providing real time estimates of the effective circulating volume and adjusting dialysate composition to maintain vascular tonicity are being developed, but currently require more sophisticated biofeedback loops to be clinically effective in preventing IDH. While awaiting advances in artificial intelligence, the clinician continues to rely on patient education to limit interdialytic weight gains, frequent assessment of the postdialysis target weight, adjusting dialysate composition and temperature, introducing convective therapies to increase thermal losses, and altering dialysis session duration and frequency to reduce ultrafiltration rate requirements.
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Affiliation(s)
- Andrew Davenport
- Department of Renal Medicine, Royal Free Hospital, Faculty of Medical Sciences, University College London, London, UK
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Meidert AS, Choukèr A, Praun S, Schelling G, Dolch ME. Exhaled Breath and Oxygenator Sweep Gas Propionaldehyde in Acute Respiratory Distress Syndrome. Molecules 2020; 26:molecules26010145. [PMID: 33396196 PMCID: PMC7796205 DOI: 10.3390/molecules26010145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Oxidative stress-induced lipid peroxidation (LPO) due to neutrophil-derived reactive oxygen species plays a key role in the early stage of the acute respiratory distress syndrome (ARDS). Monitoring of oxidative stress in this patient population is of great interest, and, ideally, this can be done noninvasively. Recently, propionaldehyde, a volatile chemical compound (VOC) released during LPO, was identified in the breath of lung transplant recipients as a marker of oxidative stress. The aim of the present study was to identify if markers of oxidative stress appear in the oxygenator outflow gas of patients with severe ARDS treated with veno-venous extracorporeal membrane oxygenation (ECMO). Methods: The present study included patients with severe ARDS treated with veno-venous ECMO. Concentrations of acetone, isoprene, and propionaldehyde were measured in inspiratory air, exhaled breath, and oxygenator inflow and outflow gas at corresponding time points. Ion-molecule reaction mass spectrometry was used to measure VOCs in a sequential order within the first 24 h and on day three after ECMO initiation. Results: Nine patients (5 female, 4 male; age = 42.1 ± 12.2 year) with ARDS and already established ECMO therapy (pre-ECMO PaO2/FiO2 = 44.0 ± 11.5 mmHg) were included into analysis. VOCs appeared in comparable amounts in breath and oxygenator outflow gas (acetone: 838 (422–7632) vs. 1114 (501–4916) ppbv; isoprene: 53.7 (19.5–244) vs. 48.7 (37.9–108) ppbv; propionaldehyde: 53.7 (32.1–82.2) vs. 42.9 (24.8–122) ppbv). Concentrations of acetone, isoprene, and propionaldehyde in breath and oxygenator outflow gas showed a parallel course with time. Conclusions: Acetone, isoprene, and propionaldehyde appear in breath and oxygenator outflow gas in comparable amounts. This allows for the measurement of these VOCs in a critically ill patient population via the ECMO oxygenator outflow gas without the need of ventilator circuit manipulation.
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Affiliation(s)
- Agnes S. Meidert
- Department of Anesthesiology, University Hospital of Munich—Campus Großhadern, Ludwig-Maximilians-University of Munich, 81366 Munich, Germany; (A.S.M.); (A.C.); (G.S.)
| | - Alexander Choukèr
- Department of Anesthesiology, University Hospital of Munich—Campus Großhadern, Ludwig-Maximilians-University of Munich, 81366 Munich, Germany; (A.S.M.); (A.C.); (G.S.)
| | - Siegfried Praun
- V&F Analyse-und Messtechnik GmbH, Andreas Hofer Strasse 15, 6067 Absam, Austria;
| | - Gustav Schelling
- Department of Anesthesiology, University Hospital of Munich—Campus Großhadern, Ludwig-Maximilians-University of Munich, 81366 Munich, Germany; (A.S.M.); (A.C.); (G.S.)
| | - Michael E. Dolch
- Department of Anesthesiology, University Hospital of Munich—Campus Großhadern, Ludwig-Maximilians-University of Munich, 81366 Munich, Germany; (A.S.M.); (A.C.); (G.S.)
- Department of Anesthesiology & Intensive Care Medicine, InnKlinikum Altötting, Vinzenz-von-Paul-Str. 10, 84503 Altötting, Germany
- Correspondence:
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Uremic Fetor Revisited: Exhaled Volatile Biomarkers in Acute Kidney Injury. Crit Care Med 2019; 47:299-300. [PMID: 30653063 DOI: 10.1097/ccm.0000000000003584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Woodward Z, Brooks P, Morris-Smith B, Wallis M, Ogbourne SM. Adsorption and Leachable Contamination of Flucloxacillin, Cyclosporin and Amiodarone Following Delivery Through an Intravenous Administration Set. Pharm Res 2018; 35:121. [PMID: 29675679 DOI: 10.1007/s11095-018-2409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/13/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Interactions between a pharmaceutical drug and its delivery device can result in changes in drug concentration and leachable contamination. Flucloxacillin, amiodarone and cyclosporin were investigated for drug concentration changes and leachable contamination after delivery through an intravenous administration set. METHODS Flucloxacillin, amiodarone and cyclosporin were delivered through an intravenous administration set and the eluate analysed by HPLC-UV and HPLC-MS. RESULTS The average recovery of flucloxacillin was 99.7% and no leachable compounds were identified. The average recovery of cyclosporin was 96.1%, which contrasts previous findings that have reported up to 50% loss of cyclosporin. This is likely due to the use of DEHP-free administration sets in this study, as adsorption of cyclosporin is linearly related to DEHP content. The average recovery of amiodarone was 91.5%. 5-hydroxymethylfurfural was identified in the amiodarone solution following delivery through the administration set as well as the 5% glucose solution used for delivery. CONCLUSIONS Drug/administration set interactions may modify pharmaceuticals during delivery. In this study, only 90% of the amiodarone was delivered through a generic administration set. Given the growing use of generic administration sets in hospital settings, validation of the suitability of their use is required to ensure patient safety and expected levels of efficacy.
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Affiliation(s)
- Zachary Woodward
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia
| | - Peter Brooks
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia
| | - Bernadette Morris-Smith
- Sunshine Coast Hospital Health Service, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Marianne Wallis
- Nursing and Midwifery Cluster for Research Excellence, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Steven M Ogbourne
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia.
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Vijayan A, Delos Santos RB, Li T, Goss CW, Palevsky PM. Effect of Frequent Dialysis on Renal Recovery: Results From the Acute Renal Failure Trial Network Study. Kidney Int Rep 2018; 3:456-463. [PMID: 29725650 PMCID: PMC5932307 DOI: 10.1016/j.ekir.2017.11.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The optimal frequency of intermittent hemodialysis (IHD) in the treatment of acute kidney injury (AKI) remains unclear. Increasing the frequency of IHD, while offering the possible advantage of reduced ultrafiltration requirement and less hemodynamic instability per session, amplifies patient contact with an extracorporeal circuit with possible deleterious cardiovascular and immunological consequences. A recent study suggested that intensive renal replacement therapy (RRT) is associated with a decrease in urine output during AKI. We hypothesized that increased frequency of IHD may be associated with delayed renal recovery. METHODS This is a post hoc analysis of the Acute Renal Failure Trial Network (ATN) study. The ATN study was a large randomized multicenter trial of intensive versus less-intensive RRT in critically ill patients with AKI. This study used either continuous RRT or IHD, depending on the hemodynamic status of the patient. Of 1124 patients, 246 were treated solely with IHD during the study period and were included in this analysis. The participants were randomized to receive IHD 3 days per week (L-IntRRT) or 6 days per week (IntRRT). The primary outcome of interest was renal recovery at day 28. RESULTS L-IntRRT was associated with higher number of RRT-free days through day 28 than IntRRT (mean difference 2.5 days; 95% confidence interval [CI]: -4.79 to -0.27 days; P = 0.028). The likelihood for renal recovery at day 28 was lower in the IntRRT group (OR: 0.49; 95% CI: 0.28-0.87; P = 0.016). CONCLUSION In hemodynamically stable patients with AKI, intensifying the frequency of IHD from 3 to 6 days per week may be associated with impaired renal recovery.
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Affiliation(s)
- Anitha Vijayan
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rowena B. Delos Santos
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Tingting Li
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Charles W. Goss
- Department of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Paul M. Palevsky
- Renal Section, VA Pittsburgh Healthcare System, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Hüppe T, Lorenz D, Wachowiak M, Maurer F, Meiser A, Groesdonk H, Fink T, Sessler DI, Kreuer S. Volatile organic compounds in ventilated critical care patients: a systematic evaluation of cofactors. BMC Pulm Med 2017; 17:116. [PMID: 28830533 PMCID: PMC5567647 DOI: 10.1186/s12890-017-0460-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 08/11/2017] [Indexed: 01/26/2023] Open
Abstract
Background Expired gas (exhalome) analysis of ventilated critical ill patients can be used for drug monitoring and biomarker diagnostics. However, it remains unclear to what extent volatile organic compounds are present in gases from intensive care ventilators, gas cylinders, central hospital gas supplies, and ambient air. We therefore systematically evaluated background volatiles in inspired gas and their influence on the exhalome. Methods We used multi-capillary column ion-mobility spectrometry (MCC-IMS) breath analysis in five mechanically ventilated critical care patients, each over a period of 12 h. We also evaluated volatile organic compounds in inspired gas provided by intensive care ventilators, in compressed air and oxygen from the central gas supply and cylinders, and in the ambient air of an intensive care unit. Volatiles detectable in both inspired and exhaled gas with patient-to-inspired gas ratios < 5 were defined as contaminating compounds. Results A total of 76 unique MCC-IMS signals were detected, with 39 being identified volatile compounds: 73 signals were from the exhalome, 12 were identified in inspired gas from critical care ventilators, and 34 were from ambient air. Five volatile compounds were identified from the central gas supply, four from compressed air, and 17 from compressed oxygen. We observed seven contaminating volatiles with patient-to-inspired gas ratios < 5, thus representing exogenous signals of sufficient magnitude that might potentially be mistaken for exhaled biomarkers. Conclusions Volatile organic compounds can be present in gas from central hospital supplies, compressed gas tanks, and ventilators. Accurate assessment of the exhalome in critical care patients thus requires frequent profiling of inspired gases and appropriate normalisation of the expired signals.
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Affiliation(s)
- Tobias Hüppe
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany.
| | - Dominik Lorenz
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany
| | - Mario Wachowiak
- Department of Anaesthesiology and Intensive Care, Klinikum Lünen St.-Marien-Hospital, Lünen, Germany
| | - Felix Maurer
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany
| | - Andreas Meiser
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany
| | - Heinrich Groesdonk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany
| | - Tobias Fink
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, ASCleveland Clinic, Cleveland, OH, USA
| | - Sascha Kreuer
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Centre of Breath Research, Saarland University Medical Centre, Kirrberger Strasse 100, 66421, Homburg (Saar), Germany
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Filipiak W, Beer R, Sponring A, Filipiak A, Ager C, Schiefecker A, Lanthaler S, Helbok R, Nagl M, Troppmair J, Amann A. Breath analysis for
in vivo
detection of pathogens related to ventilator-associated pneumonia in intensive care patients: a prospective pilot study. J Breath Res 2015; 9:016004. [DOI: 10.1088/1752-7155/9/1/016004] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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10
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Assady S, Marom O, Hemli M, Ionescu R, Jeries R, Tisch U, Abassi Z, Haick H. Impact of hemodialysis on exhaled volatile organic compounds in end-stage renal disease: a pilot study. Nanomedicine (Lond) 2014; 9:1035-45. [DOI: 10.2217/nnm.13.85] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim: To demonstrate the feasibility of nanomaterial-based sensors for identifying patterns of exhaled volatile organic compound of end-stage renal disease (ESRD) and study the impact of hemodialysis (HD) on these patterns. Patients & methods: Exhaled breath samples were collected from a group of 37 volunteers (26 ESRD HD patients; 11 healthy controls); a third of the samples were randomly blinded for determining the sensitivity/specificity of the method. Discriminant function analysis was used to build a model for discriminating ESRD patients and healthy controls (classification accuracy for blind samples: 80%), based on the signals of the nanomaterial sensors. Results & conclusion: The breath pattern of the ESRD patients approached the healthy pattern during the HD treatment, without reaching it completely. Gas chromatography/mass spectrometry identified four volatile organic compounds as potential ESRD biomarkers. Although this pilot study has yielded encouraging results, additional large-scale clinical studies are required to develop a fast, noninvasive breath test for monitoring HD adequacy in real time. Original submitted 23 September 2012; Revised submitted 26 February 2013
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Affiliation(s)
- Suheir Assady
- Department of Nephrology, Rambam Health Care Campus, Haifa 31096, Israel
| | - Ophir Marom
- Department of Chemical Engineering & Russell Berrie Nanotechnology Institute, Technion – Israel Institute of Technology, Haifa 3200003, Israel
| | - Matan Hemli
- Department of Nephrology, Rambam Health Care Campus, Haifa 31096, Israel
- Department of Physiology, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa 31096, Israel
| | - Radu Ionescu
- Department of Chemical Engineering & Russell Berrie Nanotechnology Institute, Technion – Israel Institute of Technology, Haifa 3200003, Israel
- Department of Electronics, Electrical & Automatic Engineering, Rovira i Virgili University, Tarragona 43007, Spain
| | - Raneen Jeries
- Department of Chemical Engineering & Russell Berrie Nanotechnology Institute, Technion – Israel Institute of Technology, Haifa 3200003, Israel
| | - Ulrike Tisch
- Department of Chemical Engineering & Russell Berrie Nanotechnology Institute, Technion – Israel Institute of Technology, Haifa 3200003, Israel
| | - Zaid Abassi
- Department of Physiology, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa 31096, Israel
- Research Unit, Rambam Health Care Campus, Haifa 31096, Israel
| | - Hossam Haick
- Department of Chemical Engineering & Russell Berrie Nanotechnology Institute, Technion – Israel Institute of Technology, Haifa 3200003, Israel
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Affiliation(s)
- Matthew B Rivara
- Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington
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Mochalski P, King J, Haas M, Unterkofler K, Amann A, Mayer G. Blood and breath profiles of volatile organic compounds in patients with end-stage renal disease. BMC Nephrol 2014; 15:43. [PMID: 24607025 PMCID: PMC3984739 DOI: 10.1186/1471-2369-15-43] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 02/28/2014] [Indexed: 01/20/2023] Open
Abstract
Background Monitoring of volatile organic compounds (VOCs) in exhaled breath shows great potential as a non-invasive method for assessing hemodialysis efficiency. In this work we aim at identifying and quantifying of a wide range of VOCs characterizing uremic breath and blood, with a particular focus on species responding to the dialysis treatment. Methods Gas chromatography with mass spectrometric detection coupled with solid-phase microextraction as pre-concentration method. Results A total of 60 VOCs were reliably identified and quantified in blood and breath of CKD patients. Excluding contaminants, six compounds (isoprene, dimethyl sulfide, methyl propyl sulfide, allyl methyl sulfide, thiophene and benzene) changed their blood and breath levels during the hemodialysis treatment. Conclusions Uremic breath and blood patterns were found to be notably affected by the contaminants from the extracorporeal circuits and hospital room air. Consequently, patient exposure to a wide spectrum of volatile species (hydrocarbons, aldehydes, ketones, aromatics, heterocyclic compounds) is expected during hemodialysis. Whereas highly volatile pollutants were relatively quickly removed from blood by exhalation, more soluble ones were retained and contributed to the uremic syndrome. At least two of the species observed (cyclohexanone and 2-propenal) are uremic toxins. Perhaps other volatile substances reported within this study may be toxic and have negative impact on human body functions. Further studies are required to investigate if VOCs responding to HD treatment could be used as markers for monitoring hemodialysis efficiency.
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Affiliation(s)
| | | | | | | | - Anton Amann
- Breath Research Institute, University of Innsbruck, Rathausplatz 4, A-6850 Dornbirn, Austria.
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Breath analysis of ammonia, volatile organic compounds and deuterated water vapor in chronic kidney disease and during dialysis. Bioanalysis 2014; 6:843-57. [DOI: 10.4155/bio.14.26] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The volatile metabolites present in trace amounts in exhaled breath of healthy individuals and patients, for example those with advanced chronic kidney disease (CKD), can now be detected and quantified by sensitive analytical techniques. In this review, special attention is given to the major retention metabolites resulting from dialysis-dependent CKD stage 5 and especially ammonia, as a potential estimator of the severity of uremia. However, other biomarkers are important, including the hydrocarbons isoprene, ethane and pentane, in that they are likely to indicate tissue injury associated with the dialysis treatment itself. Evaluation of over-hydration, a serious complication of CKD stage5 can be improved by analysis of deuterium in exhaled water vapor after ingestion of a known amount of deuterated water, so providing total body water measurements at the bedside to support clinical management of volume status.
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Jankowski J, Westhof T, Vaziri ND, Ingrosso D, Perna AF. Gases as Uremic Toxins: Is There Something in the Air? Semin Nephrol 2014; 34:135-50. [DOI: 10.1016/j.semnephrol.2014.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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15
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Meinardi S, Jin KB, Barletta B, Blake DR, Vaziri ND. Exhaled breath and fecal volatile organic biomarkers of chronic kidney disease. Biochim Biophys Acta Gen Subj 2013; 1830:2531-7. [PMID: 23274524 DOI: 10.1016/j.bbagen.2012.12.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 12/07/2012] [Accepted: 12/10/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND While much is known about the effect of chronic kidney disease (CKD) on composition of body fluids little is known regarding its impact on the gases found in exhaled breath or produced by intestinal microbiome. We have recently shown significant changes in the composition of intestinal microbiome in humans and animals with CKD. This study tested the hypothesis that uremia-induced changes in cellular metabolism and intestinal microbiome may modify the volatile organic metabolites found in the exhaled breath or generated by intestinal flora. METHODS SD rats were randomized to CKD (5/6 nephrectomy) or control (sham operation) groups. Exhaled breath was collected by enclosing each animal in a glass chamber flushed with clean air, then sealed for 45 min and the trapped air collected. Feces were collected, dissolved in pure water, incubated at 37 degrees C in glass reactors for 24 h and the trapped air collected. Collected gases were analyzed by gas chromatography. RESULTS Over 50 gases were detected in the exhaled breath and 36 in cultured feces. Four gases in exhaled breath and 4 generated by cultured feces were significantly different in the two groups. The exhaled breath in CKD rats showed an early rise in isoprene and a late fall in linear aldehydes. The CKD animals' cultured feces released larger amounts of dimethyldisulfide, dimethyltrisulfide, and two thioesters. CONCLUSIONS CKD significantly changes the composition of exhaled breath and gaseous products of intestinal flora. GENERAL SIGNIFICANCE Analysis of breath and bowel gases may provide useful biomarkers for detection and progression of CKD and its complications.
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Affiliation(s)
- Simone Meinardi
- Department of Chemistry, University of California Irvine, Irvine, CA, USA
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Sherman RA. Briefly Noted. Semin Dial 2013. [DOI: 10.1111/sdi.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kohl I, Beauchamp J, Cakar-Beck F, Herbig J, Dunkl J, Tietje O, Tiefenthaler M, Boesmueller C, Wisthaler A, Breitenlechner M, Langebner S, Zabernigg A, Reinstaller F, Winkler K, Gutmann R, Hansel A. First observation of a potential non-invasive breath gas biomarker for kidney function. J Breath Res 2013; 7:017110. [DOI: 10.1088/1752-7155/7/1/017110] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Anaphylactoid reaction during first hemofiltration
with a PUREMA polysulfone membrane. Int J Artif Organs 2013; 36:363-6. [PMID: 23420464 DOI: 10.5301/ijao.5000136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 12/18/2022]
Abstract
Adverse reactions during hemodialysis are extremely common and include a wide range of clinical presentations from mild to life threatening. We present a case of a 34 year old woman in the Burn Intensive Care Unit, who developed acute kidney injury requiring renal replacement therapy. She was placed on continuous veno-venous hemofiltration with the NxStage machine which uses a synthetic PUREMA polyethersulfone filter sterilized by gamma radiation. Within two minutes of initiating hemofiltration, the patient complained of pruritus as well as dyspnea and became flushed and agitated. She subsequently developed hypotension ultimately resulting in cardiopulmonary arrest. Cardiopulmonary resuscitation was initiated and the patient was given epinephrine with return of spontaneous circulation. The following day, the patient was rechallenged with a PUREMA filter, and had a similar reaction with flushing, dyspnea, pruritus and hypotension requiring treatment to be discontinued. The patient was transitioned to the Prismaflex filter, another synthetic membrane, which she tolerated well and continued to utilize through the remainder of her hospital course without complication. Her clinical presentation was consistent with an anaphylactoid reaction, though a tryptase level was not obtained and a radioallergosorbent test performed with membrane material was negative. This case shows the difficulty of identifying the cause of hypersensitivity reactions involving synthetic membranes not sterilized by ethylene oxide, a commonly use sterilizing agent known to cause hypersensitivity reactions. This rare, but potentially fatal reaction has not previously been reported with a PUREMA filter and this case should raise awareness of hypersensitivity reactions with this widely used method of renal replacement therapy.
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