Tanner Risto, Arund Jürgen, Fridolin Ivo, Luman Merike
Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, Akadeemia tee 5, 19086 Tallinn, Estonia ; National Institute of Chemical Physics and Biophysics, Akadeemia tee 23, 12618 Tallinn, Estonia.
Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, Akadeemia tee 5, 19086 Tallinn, Estonia.
ISRN Nephrol. 2013 Oct 3;2013:515292. doi: 10.5402/2013/515292. eCollection 2013.
The aim of this study was to assess removal dynamics of paracetamol (PAR), as an extraordinary chromophore in spent dialysate, upon the optical monitoring of dialysis of end-stage renal disease patients with inflammation complications. Seven dialysis sessions of different patients were followed to whom PAR was used as a pain reliever or antipyretic. Spent dialysate was sampled hourly and analyzed using HPLC with MS/MS and UV detection. Quantitative calculations were made on the basis of the peak areas on the chromatograms at 280 nm for uric acid (UA) and 254 nm for PAR and its metabolites (PAR-M). Peaks of UA, PAR, PAR-glucuronide, and PAR-sulphate were identified on the basis of specific mass spectra. Removal of PAR was found to be proportional to that of uric acid if intake of the drug by patient occurred half a day before dialysis. But disturbances of the UV-absorbance curves at 280 nm were observed related to rise of UA concentration in spent dialysate when PAR was taken by patients in the course of dialysis. The mechanism of such relation remains unknown. It was concluded that possible benefits and risks of treatment of uremic patients with paracetamol-containing drugs may need to be reassessed.
本研究的目的是通过对患有炎症并发症的终末期肾病患者透析过程进行光学监测，评估作为用过的透析液中一种特殊发色团的对乙酰氨基酚（PAR）的清除动力学。对7例不同患者的透析过程进行了跟踪，这些患者使用PAR作为止痛剂或退烧药。每小时采集用过的透析液样本，并使用配有质谱/质谱和紫外检测的高效液相色谱法进行分析。基于尿酸（UA）在280 nm处和PAR及其代谢物（PAR-M）在254 nm处色谱图上的峰面积进行定量计算。根据特定质谱图鉴定出UA、PAR、PAR-葡萄糖醛酸苷和PAR-硫酸盐的峰。如果患者在透析前半天服用药物，发现PAR的清除与尿酸的清除成正比。但是当患者在透析过程中服用PAR时，观察到280 nm处的紫外吸收曲线与用过的透析液中UA浓度的升高有关。这种关系的机制尚不清楚。得出的结论是，含对乙酰氨基酚药物治疗尿毒症患者的潜在益处和风险可能需要重新评估。
