{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:08:15Z","timestamp":1790842095239,"version":"4.1.0"},"reference-count":59,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,2,23]],"date-time":"2020-02-23T00:00:00Z","timestamp":1582416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","award":["767572"],"award-info":[{"award-number":["767572"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Estonian Ministry of Education and Research","award":["IUT 19-2"],"award-info":[{"award-number":["IUT 19-2"]}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["TAR16013"],"award-info":[{"award-number":["TAR16013"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Tryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS) and indole acetic acid (IAA), in ESKD patients in different dialysis treatment settings. This prospective multicentre study in four European dialysis centres enrolled 78 patients with ESKD. Blood and spent dialysate samples obtained during dialysis were analysed with high-performance liquid chromatography to assess uremic solutes, their reduction ratio (RR) and total removed solute (TRS). Mean free serum tryptophan and IS concentrations increased, and concentration of IAA decreased over pre-dialysis levels (67%, 49%, \u22120.8%, respectively) during the first hour of dialysis. While mean serum total urea, IS and IAA concentrations decreased during dialysis (\u221272%, \u221239%, \u221243%, respectively), serum tryptophan levels increased, resulting in negative RR (\u22128%) towards the end of the dialysis session (p &lt; 0.001), despite remarkable Trp losses in dialysate. RR and TRS values based on serum (total, free) and dialysate solute concentrations were lower for conventional low-flux dialysis (p &lt; 0.001). High-efficiency haemodiafiltration resulted in 80% higher Trp losses than conventional low-flux dialysis, despite similar neutral Trp RR values. In conclusion, serum Trp concentrations and RR behave differently from uremic solutes IS, IAA and urea and Trp RR did not reflect dialysis Trp losses. Conventional low-flux dialysis may not adequately clear Trp-related uremic toxins while high efficiency haemodiafiltration increased Trp losses.<\/jats:p>","DOI":"10.3390\/ijms21041522","type":"journal-article","created":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T03:33:43Z","timestamp":1582515223000},"page":"1522","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1862-1038","authenticated-orcid":false,"given":"Joosep","family":"Paats","sequence":"first","affiliation":[{"name":"Department of Health Technologies, Tallinn University of Technology, 19086 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Adoberg","sequence":"additional","affiliation":[{"name":"Centre of Nephrology, North Estonia Medical Centre, 13419 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Arund","sequence":"additional","affiliation":[{"name":"Department of Health Technologies, Tallinn University of Technology, 19086 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemieke","family":"Dhondt","sequence":"additional","affiliation":[{"name":"Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Fernstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Department of Medicine and Health Science, Link\u00f6ping University, 58185 Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7374-4287","authenticated-orcid":false,"given":"Ivo","family":"Fridolin","sequence":"additional","affiliation":[{"name":"Department of Health Technologies, Tallinn University of Technology, 19086 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7641-4707","authenticated-orcid":false,"given":"Griet","family":"Glorieux","sequence":"additional","affiliation":[{"name":"Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liisi","family":"Leis","sequence":"additional","affiliation":[{"name":"Centre of Nephrology, North Estonia Medical Centre, 13419 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merike","family":"Luman","sequence":"additional","affiliation":[{"name":"Department of Health Technologies, Tallinn University of Technology, 19086 Tallinn, Estonia"},{"name":"Centre of Nephrology, North Estonia Medical Centre, 13419 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Gonzalez-Parra","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital Health Research Institute, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa Maria","family":"Perez-Gomez","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital Health Research Institute, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2422-0430","authenticated-orcid":false,"given":"Kristjan","family":"Pilt","sequence":"additional","affiliation":[{"name":"Department of Health Technologies, Tallinn University of Technology, 19086 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Sanchez-Ospina","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital Health Research Institute, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e5rten","family":"Segelmark","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Department of Medicine and Health Science, Link\u00f6ping University, 58185 Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Uhlin","sequence":"additional","affiliation":[{"name":"Department of Health Technologies, Tallinn University of Technology, 19086 Tallinn, Estonia"},{"name":"Department of Nephrology and Department of Medicine and Health Science, Link\u00f6ping University, 58185 Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9805-9523","authenticated-orcid":false,"given":"Alberto","family":"Arduan Ortiz","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital Health Research Institute, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1038\/ejcn.2015.144","article-title":"Plasma concentrations and intakes of amino acids in male meat-eaters, fish-eaters, vegetarians and vegans: A cross-sectional analysis in the epic-oxford cohort","volume":"70","author":"Schmidt","year":"2016","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/S0899-9007(02)00780-3","article-title":"Plasma amino acid levels with a note on membrane transport: Characteristics, regulation, and metabolic significance","volume":"18","author":"Cynober","year":"2002","journal-title":"Nutrition"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1172\/JCI103568","article-title":"Unbound amino acid concentrations in human blood plasmas","volume":"36","author":"McMenamy","year":"1957","journal-title":"J. Clin. Investig."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0009-8981(96)06504-7","article-title":"Serum uremic toxins from patients with chronic renal failure displace the binding of l-tryptophan to human serum albumin","volume":"260","author":"Mingrone","year":"1997","journal-title":"Clin. Chim. Acta"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"IJTR","DOI":"10.4137\/IJTR.S2129","article-title":"L-tryptophan: Basic metabolic functions, behavioral research and therapeutic indications","volume":"2","author":"Richard","year":"2009","journal-title":"Int. J. Tryptophan Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/BF00637514","article-title":"Pharmacokinetics of tryptophan, renal handling of kynurenine and the effect of nicotinamide on its appearance in plasma and urine following l-tryptophan loading of healthy subjects","volume":"21","year":"1981","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/0098-2997(83)90005-5","article-title":"Biochemistry of tryptophan in health and disease","volume":"6","author":"Bender","year":"1983","journal-title":"Mol. Asp. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/j.1365-2125.1980.tb00516.x","article-title":"Metabolism of an oral tryptophan load. I: Effects of dose and pretreatment with tryptophan","volume":"10","author":"Green","year":"1980","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.chom.2018.05.003","article-title":"Gut microbiota regulation of tryptophan metabolism in health and disease","volume":"23","author":"Agus","year":"2018","journal-title":"Cell Host Microbe"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.phrs.2018.03.003","article-title":"Microbiota metabolites: Pivotal players of cardiovascular damage in chronic kidney disease","volume":"130","author":"Cosola","year":"2018","journal-title":"Pharmacol. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1053\/j.ajkd.2015.08.029","article-title":"Future avenues to decrease uremic toxin concentration","volume":"67","author":"Vanholder","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Adrian, P., Marleen, H., Enya, P., Martijn van, F., Ido, P.K., Steffie, V., Johanna, M.G., Ralf, W., Karin, J.R.I., and Stephan, J.L.B. (2019). Tryptophan intake and tryptophan losses in hemodialysis patients: A balance study. Nutrients, 11.","DOI":"10.3390\/nu11122851"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/j.ekir.2019.05.001","article-title":"Micronutrient and amino acid losses during renal replacement therapy for acute kidney injury","volume":"4","author":"Weng","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1159\/000500998","article-title":"Amino acid loss during continuous venovenous hemofiltration in critically ill patients","volume":"48","author":"Stapel","year":"2019","journal-title":"Blood Purif."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1159\/000335607","article-title":"Amino acid balance with extended daily diafiltration in acute kidney injury","volume":"33","author":"Chua","year":"2012","journal-title":"Blood Purif."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1097\/00003246-199112000-00012","article-title":"Amino acid clearances and daily losses in patients with acute renal failure treated by continuous arteriovenous hemodialysis","volume":"19","author":"Davies","year":"1991","journal-title":"Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1177\/039139880202500403","article-title":"High protein intake during continuous hemodiafiltration: Impact on amino acids and nitrogen balance","volume":"25","author":"Bellomo","year":"2002","journal-title":"Int. J. Artif. Organs"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/BF00806091","article-title":"L-tryptophan: Biochemical, nutritional and pharmacological aspects","volume":"10","author":"Sainio","year":"1996","journal-title":"Amino Acids"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1038\/ki.1994.339","article-title":"Amino acid and albumin losses during hemodialysis","volume":"46","author":"Flakoll","year":"1994","journal-title":"Kidney Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1007\/s00726-010-0752-7","article-title":"Tryptophan metabolism, from nutrition to potential therapeutic applications","volume":"41","author":"Otten","year":"2011","journal-title":"Amino Acids"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1093\/ndt\/gfq803","article-title":"Comparison of removal capacity of two consecutive generations of high-flux dialysers during different treatment modalities","volume":"26","author":"Meert","year":"2011","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1681\/ASN.2011121175","article-title":"Normal and pathologic concentrations of uremic toxins","volume":"23","author":"Duranton","year":"2012","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1007\/s00216-012-5929-3","article-title":"Protein-bound uremic toxins in hemodialysis patients measured by liquid chromatography\/tandem mass spectrometry and their effects on endothelial ros production","volume":"403","author":"Itoh","year":"2012","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.biochi.2017.09.018","article-title":"Using binding competitors of albumin to promote the removal of protein-bound uremic toxins in hemodialysis: Hope or pipe dream?","volume":"144","author":"Florens","year":"2018","journal-title":"Biochimie"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1681\/ASN.2013121283","article-title":"The cardiovascular effect of the uremic solute indole-3 acetic acid","volume":"26","author":"Dou","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Leong, S.C., and Sirich, T.L. (2016). Indoxyl sulfate-review of toxicity and therapeutic strategies. Toxins (Basel), 8.","DOI":"10.3390\/toxins8120358"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/j.1525-1594.2010.01005.x","article-title":"Prospective evaluation of the change of predialysis protein-bound uremic solute concentration with postdilution online hemodiafiltration","volume":"34","author":"Meert","year":"2010","journal-title":"Artif. Organs"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1093\/ndt\/gfp437","article-title":"Protein-bound uraemic toxin removal in haemodialysis and post-dilution haemodiafiltration","volume":"25","author":"Krieter","year":"2010","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3933","DOI":"10.3390\/toxins7103933","article-title":"Exploring protein binding of uremic toxins in patients with different stages of chronic kidney disease and during hemodialysis","volume":"7","author":"Deltombe","year":"2015","journal-title":"Toxins (Basel)"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1093\/ndt\/gfw100","article-title":"Effect of a sustained difference in hemodialytic clearance on the plasma levels of p-cresol sulfate and indoxyl sulfate","volume":"31","author":"Camacho","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"394","DOI":"10.2215\/CJN.05240418","article-title":"Removal of protein-bound uremic toxins during hemodialysis using a binding competitor","volume":"14","author":"Madero","year":"2019","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_32","first-page":"396","article-title":"Is there a relationship between tryptophan dietary intake and plasma levels of indoxyl sulfate in chronic kidney disease patients on hemodialysis?","volume":"38","author":"Borges","year":"2016","journal-title":"Braz. J. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Fernandez-Prado, R., Esteras, R., Perez-Gomez, M.V., Gracia-Iguacel, C., Gonzalez-Parra, E., Sanz, A.B., Ortiz, A., and Sanchez-Ni\u00f1o, M.D. (2017). Nutrients turned into toxins: Microbiota modulation of nutrient properties in chronic kidney disease. Nutrients, 9.","DOI":"10.3390\/nu9050489"},{"key":"ref_34","first-page":"287","article-title":"Tryptophanase: Structure, catalytic activities, and mechanism of action","volume":"42","author":"Snell","year":"1975","journal-title":"Adv. Enzymol. Relat. Areas Mol. Biol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2312","DOI":"10.1046\/j.1432-1033.2003.03601.x","article-title":"Crystal structure of thiamindiphosphate-dependent indolepyruvate decarboxylase from enterobacter cloacae, an enzyme involved in the biosynthesis of the plant hormone indole-3-acetic acid","volume":"270","author":"Sandalova","year":"2003","journal-title":"Eur. J. Biochem."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/S0387-7604(86)80064-X","article-title":"Plasma free tryptophan concentration in autistic children","volume":"8","author":"Hoshino","year":"1986","journal-title":"Brain Dev."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1178646917694600","DOI":"10.1177\/1178646917694600","article-title":"Tryptophan metabolism in patients with chronic kidney disease secondary to type 2 diabetes: Relationship to inflammatory markers","volume":"10","author":"Debnath","year":"2017","journal-title":"Int. J. Tryptophan Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1111\/eci.12402","article-title":"Low serum tryptophan predicts higher mortality in cardiovascular disease","volume":"45","author":"Murr","year":"2015","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_39","first-page":"314","article-title":"Increases in plasma tryptophan are inversely associated with incident cardiovascular disease in the prevenci\u00f3n con dieta mediterr\u00e1nea (predimed) study","volume":"147","author":"Yu","year":"2017","journal-title":"J. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/MCO.0b013e32834d9df6","article-title":"Effect of kidney failure and hemodialysis on protein and amino acid metabolism","volume":"15","author":"Garibotto","year":"2012","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1038\/ki.2008.21","article-title":"Interleukin-6 modulates hepatic and muscle protein synthesis during hemodialysis","volume":"73","author":"Raj","year":"2008","journal-title":"Kidney Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1093\/ajcn\/33.7.1402","article-title":"Tryptophan and indolic tryptophan metabolites in chronic renal failure","volume":"33","author":"Saito","year":"1980","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/0009-8981(73)90261-1","article-title":"The effect of haemodialysis on the binding capacity of albumin","volume":"46","author":"Dromgoole","year":"1973","journal-title":"Clin. Chim. Acta"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1159\/000169015","article-title":"Significance of serum lipase in patients undergoing hemodialysis","volume":"16","author":"Shibasaki","year":"1996","journal-title":"Am. J. Nephrol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/BF00637572","article-title":"Plasma free fatty acids and protein binding of disopyramide during haemodialysis","volume":"33","author":"Horiuchi","year":"1987","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jchromb.2015.09.041","article-title":"Chromatographic analysis of the effects of fatty acids and glycation on binding by probes for sudlow sites i and ii to human serum albumin","volume":"1021","author":"Anguizola","year":"2016","journal-title":"J. Chromatogr. B"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"23389","DOI":"10.1038\/srep23389","article-title":"Improved dialytic removal of protein-bound uraemic toxins with use of albumin binding competitors: An in vitro human whole blood study","volume":"6","author":"Tao","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1248\/bpb.18.1755","article-title":"Characterization of binding site of uremic toxins on human serum albumin","volume":"18","author":"Sakai","year":"1995","journal-title":"Biol. Pharm. Bull."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1042\/bj1460653","article-title":"The binding of l-tryptophan to serum albumins in the presence of non-esterified fatty acids","volume":"146","author":"Cunningham","year":"1975","journal-title":"Biochem. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.biochi.2017.05.010","article-title":"Exploring binding characteristics and the related competition of different protein-bound uremic toxins","volume":"139","author":"Deltombe","year":"2017","journal-title":"Biochimie"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Lauri, K., Arund, J., Holmar, J., Tanner, R., Kalle, S., Luman, M., Fridolin, I., Tanner, R., Kalle, S., and Luman, M. (2019). Removal of urea, \u03b22-microglobulin, and indoxyl sulfate assessed by absorbance and fluorescence in the spent dialysate during hemodialysis. ASAIO J.","DOI":"10.1097\/MAT.0000000000001058"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"3278","DOI":"10.1093\/ndt\/gfs060","article-title":"Removal of water-soluble and protein-bound solutes with reversed mid-dilution versus post-dilution haemodiafiltration","volume":"27","author":"Eloot","year":"2012","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Arund, J., Luman, M., Uhlin, F., Tanner, R., and Fridolin, I. (2016). Is fluorescence valid to monitor removal of protein bound uremic solutes in dialysis?. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0156541"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1093\/ndt\/15.1.50","article-title":"Intradialytic removal of protein-bound uraemic toxins: Role of solute characteristics and of dialyser membrane","volume":"15","author":"Lesaffer","year":"2000","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1053\/j.jrn.2018.07.005","article-title":"Differences in amino acid loss between high-efficiency hemodialysis and postdilution and predilution hemodiafiltration using high convection volume exchange-a new metabolic scenario? A pilot study","volume":"29","author":"Murtas","year":"2019","journal-title":"J. Renal Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Hendriks, F.K., Smeets, J.S.J., Broers, N.J.H., van Kranenburg, J.M.X., van der Sande, F.M., Kooman, J.P., and van Loon, L.J.C. (2020). End-stage renal disease patients lose a substantial amount of amino acids during hemodialysis. J. Nutr.","DOI":"10.1093\/jn\/nxaa010"},{"key":"ref_57","unstructured":"GBD 2017 DALYs and HALE, Collaborators (2018). Global, regional, and national disability-adjusted life-years (dalys) for 359 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2017: A systematic analysis for the global burden of disease study 2017. Lancet, 392, 1859\u20131922."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/ckj\/sfz011","article-title":"The european renal association\u2009\u2013\u2009european dialysis and transplant association (era-edta) registry annual report 2016: A summary","volume":"12","author":"Kramer","year":"2019","journal-title":"Clin. Kidney J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2962","DOI":"10.1093\/ndt\/gfm356","article-title":"Temperature and concentration distribution within the genius\u00ae dialysate container","volume":"22","author":"Eloot","year":"2007","journal-title":"Nephrol. Dial. Transplant."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/21\/4\/1522\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:01:07Z","timestamp":1760173267000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/21\/4\/1522"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,23]]},"references-count":59,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["ijms21041522"],"URL":"https:\/\/doi.org\/10.3390\/ijms21041522","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,23]]}}}