{
  "abstract": "Current hemodialysis (HD) methods inefficiently remove protein-bound uremic toxins (PBUTs) due to their high binding affinity to plasma proteins, mainly albumin. This study aimed to investigate electromagnetic (EM) fields and temperature as potential extracorporeal, non-systemic methods to increase HD PBUT clearance. PBUT release was measured in infusible (caprylate-stabilized) albumin solutions spiked with indoxyl sulfate (IS) using an in vitro dialysis setup including a real-time, in-line IS-sensor. No measurable influence on PBUT release was observed during EM field-tests (f = 1-600 MHz, E <= 1 kV/m), but temperature tests (35-40 °C range) showed an absolute increase in IS free fraction of 0.7%/°C. Furthermore, static equilibrium dialysis tests, including IS, p-cresyl sulfate (pCS) and hippuric acid (HA), showed a free fraction increase for all three PBUTs upon a temperature increase from 37 °C to 43 °C (IS 1.30-fold, pCS 1.12-fold, HA 1.15-fold). Mathematical modeling showed a 1.14-fold decrease in plasma IS concentration after 5 weeks of HD, and exploratory hemocompatibility tests did not reveal pronounced changes over 15 heating cycles at 43 °C under static conditions. Extracorporeal temperature elevation is a promising technique to enhance PBUT removal during hemodialysis, which may be easily combined with current HD machines, does not break sterility, and avoids elevating free PBUTs inside the body.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Nephrology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.",
    "IMEC the Netherlands-Health Research, 5656 AE Eindhoven, The Netherlands.",
    "European Kidney Health Alliance (EKHA), 1000 Brussels, Belgium.",
    "Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.",
    "Division of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands.",
    "Aachen-Maastricht Institute for Cardiorenal Disease (AMICARE), University Hospital RWTH Aachen, 52074 Aachen, Germany.",
    "BIOS Lab on a Chip Group, Faculty of EEMCS, University of Twente, 7500 AE Enschede, The Netherlands."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "João G Brás",
      "orcid": "0009-0000-7238-1998"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Fokko P Wieringa",
      "orcid": "0000-0002-7759-7816"
    },
    {
      "affs": [
        0
      ],
      "name": "Babette H Lentferink"
    },
    {
      "affs": [
        0
      ],
      "name": "Simon Kootwijk"
    },
    {
      "affs": [
        3
      ],
      "name": "Albert H Westra"
    },
    {
      "affs": [
        3
      ],
      "name": "Leonard J van Schelven",
      "orcid": "0000-0001-7903-0306"
    },
    {
      "affs": [
        4
      ],
      "name": "Mies van Steenbergen",
      "orcid": "0000-0003-1578-9983"
    },
    {
      "affs": [
        5
      ],
      "name": "Joachim Jankowski"
    },
    {
      "affs": [
        0
      ],
      "name": "Marianne C Verhaar",
      "orcid": "0000-0002-3276-6428"
    },
    {
      "affs": [
        0
      ],
      "name": "Karin G F Gerritsen",
      "orcid": "0000-0002-1917-6255"
    },
    {
      "affs": [
        0,
        1,
        6
      ],
      "name": "Jeroen C Vollenbroek",
      "orcid": "0000-0002-0778-3509"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/13tvcspaymt27.bib",
  "cited_by": 0,
  "doi": "10.3390/toxins18100443",
  "fulltext_url": "https://europepmc.org/articles/PMC13709536",
  "id": "13tvcspaymt27",
  "issns": [
    "2072-6651"
  ],
  "landing_url": "https://europepmc.org/article/MED/42931534",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2727|Dialysis and Renal Disease Management"
    ]
  ],
  "openalex": "W7221657282",
  "pdf_url": "https://europepmc.org/articles/PMC13709536?pdf=render",
  "pmcid": "PMC13709536",
  "pmid": "42931534",
  "published": "2026-10-13",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/13tvcspaymt27.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:22:01Z",
      "native_id": "MED:42931534",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42931534"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2727|Dialysis and Renal Disease Management",
      "subfield": "general"
    }
  ],
  "title": "Evaluation of Two Non-Invasive Extracorporeal Strategies for Enhancing Protein-Bound Uremic Toxin Removal During Hemodialysis.",
  "title_text": "Evaluation of Two Non-Invasive Extracorporeal Strategies for Enhancing Protein-Bound Uremic Toxin Removal During Hemodialysis.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:22:01Z",
  "url": "https://research.draconitic.com/paper/13tvcspaymt27",
  "venue": "Toxins",
  "versions": []
}