Assessment of urea and other uremic markers for quantification of dialysis efficacy

To validate azotemic markers as an index for intradialytic changes in solute concentration, we compared eight solutes (pseudouridine, xanthine, hypoxanthine, peak 4, peak 5, p-hydroxyhippuric acid, indoxyl sulfate, and hippuric acid) with five classical azotemic markers (urea, creatinine, uric acid, phosphate, and potassium). We determined concentrations by reversed-phase HPLC coupled to ultraviolet absorption or photometrically. Seven compounds showed significant intercorrelation (P less than 10(-5)): urea, pseudouridine, uric acid, peaks 4 and 5, p-hydroxyhippuric acid, and creatinine. The hippuric acid concentration change after dialysis correlated with the change for these seven compounds and also with indoxyl sulfate, hypoxanthine, potassium, and the group of unidentified ultraviolet-absorbing HPLC peaks accumulating in uremia. We conclude that urea only partially represents the concentration changes of other retention compounds after dialysis; alternative markers, e.g., hippurate, should be considered.