Liu Wen-Sheng, Lin Chien-Hung, Li Szu-Yuan, Lin Chih-Ching, Liu Tsung-Yun, Tan Ann Charis, Tsou Han-Hsing, Chan Hsiang-Lin, Lai Yen-Ting
Division of Nephrology, Department of Medicine, Taipei City Hospital Zhongxing Branch, Taipei 103, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan.
Membranes (Basel). 2022 Aug 13;12(8):778. doi: 10.3390/membranes12080778.
Serum creatinine is an important clinical marker for renal clearance. However, two conventional methods (Jaffe and enzymatic) are prone to interferences with organic compounds as compared to the standard method (isotope dilution-liquid chromatography-mass spectrometry) and can cause a significant negative bias. Perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA) are two common perfluorochemicals (PFCs) that can easily be accumulated in humans. We aimed to verify whether this bias is the result of an accumulation of PFCs. The serum creatinine values of 124 hemodialysis patients were analyzed using the three methods. We also aimed to evaluate which biochemical parameters will influence the difference between the conventional methods and the standard method. We found that a significant underestimation occurred when using the conventional methods. Albumin is an independent factor associated with negative bias, but it loses this correlation after dialysis, likely due to the removal of protein-bound uremic toxins. PFOS can cause negative bias when using the enzymatic method. Furthermore, this linear correlation is more significant in patients who used polysulfone-based dialysis membranes, possibly due to the better clearance of other uremic toxins. The serum creatinine of uremic patients can be significantly underestimated when using conventional methods. PFCs, as well the type of dialysis membrane being used, can be influencing factors.
血清肌酐是反映肾脏清除功能的重要临床指标。然而，与标准方法（同位素稀释-液相色谱-质谱法）相比，两种传统方法（Jaffe法和酶法）容易受到有机化合物的干扰，可能导致显著的负偏差。全氟辛烷磺酸（PFOS）和全氟辛酸（PFOA）是两种常见的全氟化合物（PFCs），它们很容易在人体内蓄积。我们旨在验证这种偏差是否是PFCs蓄积的结果。我们使用这三种方法分析了124例血液透析患者的血清肌酐值。我们还旨在评估哪些生化参数会影响传统方法与标准方法之间的差异。我们发现，使用传统方法时会出现显著的低估。白蛋白是与负偏差相关的独立因素，但透析后这种相关性消失，可能是由于与蛋白结合的尿毒症毒素被清除。使用酶法时，PFOS会导致负偏差。此外，在使用聚砜基透析膜的患者中，这种线性相关性更为显著，这可能是由于其他尿毒症毒素的清除效果更好。使用传统方法时，尿毒症患者的血清肌酐可能会被显著低估。PFCs以及所使用的透析膜类型可能是影响因素。
