#615 The choice of anti-inflammatory influences the elimination of protein-bound uremic toxins

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Abstract Background and Aims Pain is a frequent and debilitating symptom affecting nearly 60% of hemodialysis patients, significantly reducing their quality of life. Protein-bound uremic toxins (PBUTs), such as indoxyl sulfate (IS) and p-cresyl sulfate (pCS), contribute to increased cardiovascular risk and mortality and are challenging to eliminate with conventional hemodialysis due to their high protein affinity. This study aimed to evaluate the effectiveness of ibuprofen (800 mg) in enhancing PBUT removal compared to other commonly used analgesics, including lysine acetylsalicylic acid (900 mg), acetaminophen (1 g), and dexketoprofen (50 mg), during post-dilution hemodiafiltration (HDF) since its competitive capability demonstrated currently. Method A prospective, single-center study was conducted involving 23 patients (11 women) with a mean age of 71 ± 14 years. Each patient underwent four hemodiafiltration (HDF) sessions under standard post-dilutional parameters. The analgesics were alternated, and all other dialysis settings were maintained constant. Reduction ratios (RRs) for small, medium, and protein-bound molecules, including IS and pCS, were assessed. Samples were analyzed using advanced techniques, such as liquid chromatography-mass spectrometry, to ensure precision. Dose of analgesic were Results Our findings revealed that ibuprofen significantly improved the RRs of IS and pCS compared to the other analgesics (Fig. 1), while no differences were observed in the clearance of smaller or medium-sized molecules. Pain control was achieved across all treatments, and no adverse drug reactions were reported during the study. The superior efficacy of ibuprofen in enhancing PBUT removal is attributed to its competitive displacement of these toxins from protein-binding sites, a mechanism not observed with the other analgesics studied. Conclusion This dual benefit—effective pain relief and improved toxin clearance—highlights the potential of ibuprofen as a preferred analgesic for hemodialysis patients. However, further long-term studies are necessary to assess the safety, optimal dosing, and clinical significance of this approach. The development of additional PBUT-displacing agents and adsorptive membranes also warrants exploration to enhance toxin removal further

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