%0 Journal Article
%T Paracetamol Interference in Uric Acid Levels in Uremic Patients Revealed by Monitoring Spent Dialysate
%A Risto Tanner
%A J¨¹rgen Arund
%A Ivo Fridolin
%A Merike Luman
%J ISRN Nephrology
%D 2013
%R 10.5402/2013/515292
%X 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. 1. Introduction Uric acid (UA) is known as a normal final product of human metabolism of purines, essential constituents of nucleic acids, and is normally excreted by kidney with urine [1]. High concentration of UA in serum often associates with severe chronic pathologies, such as arthritis, hypertension, and so forth [2]. Many recommendations have been published for such patients listing purine-rich food products to be avoided as well as some drugs, which are known to be associated with a raise of UA in blood, but paracetamol (PAR), a worldwide used analgesic and antipyretic drug [3], is not usually included into such lists. Paracetamol (PAR) is known as a potent enhancer of the effect of many other drugs [4] and its combination with analgesic drugs as pain reliever, including treatment of acute gout-like arthritis associated with high level of UA in blood [5]. Some observations have been published in the older literature concerning elevated analytical results of UA in serum following PAR administration, but this effect was found to be caused by interference of PAR with phosphotungstate reduction method of UA analysis only and an alternative uricase method did not confirm relationship between UA concentration and PAR administration [6, 7]. Since no strong limitation is known, PAR is dosed sometimes also to patients with renal failure as an analgesic or
%U http://www.hindawi.com/journals/isrn.nephrology/2013/515292/