Exhaled breath volatile organic and inorganic compound composition in end-stage renal disease

Aims: Patients with end-stage renal disease (ESRD) are characterized by uremia and increased oxidative stress. The aim of this study was to investigate the influence of hemodialysis on breath ammonia and volatile oxidative stress parameters. Methods: Breath analysis was performed in 18 ESRD patients prior, during, and 30 minutes after a hemodialysis session. Parameters of hemodialysis efficiency and oxidative stress (lipid peroxides, total antioxidative capacity, myeloperoxidase, and malondialdehyde) were measured in blood at the beginning, after 30 minutes, and at the end of the dialysis session. 11 healthy volunteers with normal renal function served as a control group. Ion-molecule reaction mass spectrometry was used for breathgas analysis. Results: Initial elevated concentrations of breath ammonia decreased during hemodialysis and correlated with serum urea levels (r(2) = 0.74), whereas isoprene concentrations increased. Breath concentrations of malondialdehyde and pentane (MDA-P) were significantly elevated in ESRD patients (p < 0.01). Within the blood, a significant decrease of malondialdehyde was notable during hemodialysis treatment, whereas levels of lipid peroxides and myeloperoxidase increased. Conclusion: Exhaled breath of patients with ESRD on regular hemodialysis treatment is characterized by an increase in ammonia and MDA-P. The efficient decrease of breath ammonia and its close correlation to serum urea during hemodialysis suggests its possible use as a noninvasive marker to monitor dialysis efficacy.