I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Bill Peckham on April 01, 2009, 01:58:29 PM
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DSEN (http://www.billpeckham.com/) has made an online early advance access abstract available: Olfaction measure of asparagus cacosmia solute removal via low dialysate flow hemodialysis (http://www.billpeckham.com/from_the_sharp_end_of_the/2009/04/removal-of-aspharagos-cacosmia-molecules-via-hemodialysis-confirmed.html):
Olfaction measure of asparagus cacosmia solute removal via low dialysate flow hemodialysis.
William L. Peckham1; Anna L. Bennett2
Correspondence and offprint requests to: William L. Peckham, DSEN, Division of Blog Research, Seattle, WA USA. Email: bill.peckham @ yahoo.com
Abstract
Context. Humankind has long been vexed by cacosmia that accompanies natural renal output post asparagus consumption. A 50 year survey of nephrology peer reviewed literature indicates that questions surrounding hemodialysis removal of the asparagus cacosmia solute have not been addressed.
Objective. To determine the efficacy of low dialysate flow hemodialysis in removing the asparagus cacosmia solute.
Design, Setting, and Participants. Participants were recruited via email and at an informational table set up at the 2008 Stockton Asparagus Festival (http://www.asparagusfest.com/), California's largest charitable festival3. Complete study results will be presented at the 2009 Stockton Asparagus Festival (http://www.asparagusfest.com/) poster session. Participants were categorized by renal function; those who were healthy or were found to have Chronic Kidney Disease 1 (CKD1) or 2 (CKD2) (GFR = 60->90mL/min/1.73 m2) were assigned the Urinator group (Ug). Those with CKD5 (GFR = <15 mL/min/1.73 m2 or post transplant) were assigned to the Dialyzor group (Dg). The Dg group was further distinguished as managing CKD5 with dialysis (DgD) or managing CKD5 with renal allograft (DgT). All DgD participants managed their CKD5 with home hemodialysis using the NxStage cycler and dialysate flow rates 115mm/min +/-25ml/min. Each group (Ug (n=30), DgD (n=16), DgT (n=10)) were randomized into a control group which ingested 500g (+/-50g) of steamed Asparaguisetm 4 (A1), or the study group which ingested 500g (+/- 50g) of steamed Stockton Valley Asparagus (A2). Participants were instructed to fast, ingesting only water for 6 hours prior to initiating the study. The DgT and Ug cohorts were instructed to void before eating and then to collect 100ml samples during the three post ingestion voiding episodes. DgD were instructed to eat their study material 2 hours prior to their dialysis treatment and to collect 100ml dialysate samples every 30 minutes commencing 10 minutes after initiation of treatment.
Main Outcome Measures. To establish the odor concentration, an olfactometer was used which employed a panel of test persons. A sample of Ug natural output post asparagus ingestion and an odor-free gas (as a reference) were presented from sniffing ports to a group of panelists (n=10; the panelists must fulfill certain requirements, for example regarding their sensitivity of odor perception; the gas used to verify this requirement was n-Butanol). In comparing the gases emitted from each port, the panelists were asked to report the presence of odor. The gas-diluting ratio was then decreased by a factor of 1.4 or two (i.e. the concentration is increased accordingly). The panelists were then asked to repeat their judgment. This continued for a number of dilution levels. The responses of the panelists over a range of dilution settings are used to calculate the concentration of the odor in terms of European Odor Units (OUE/m3).
Results. The Ug A1 cohort output was measured to be OUE=2 which is within the margin of error for human urine, and stayed level across all samples. The Ug A2 cohort's output measured OUE=4 on the first sample, OUE=3 on the second sample before plateauing at the OUE=2 baseline on subsequent sampling. The DgT A1 cohort and DgT A2 cohort results matched those of the paired Ug cohorts. The DgD A1 cohort output was measured at OUE=1 which is within the margin of error for post use dialysate, and stayed level across all samples. The DgD A2 cohort's output measured OUE=3 on the first, second and third dialysate sample, the forth and fifth samples measured OUE=2, the 6th and subsequent samples were measured to be at the OUE=1 baseline.
Conclusion. Asparagus cacosmia solutes are removed during hemodialysis using low dialysate flow rates. The study was under powered to distinguish removal across varying blood flows and dialysate flows. Phase 2 of the study will look to confirm asparagus cacosmia solute removal via peritoneal dialysis and look in more detail at asparagus cacosmia solute removal as a measure of dialysis adequacy, confirming initial results that correlate OUE to adequacy targets as closely as Kt/V. Phase 2 should confirm that a post dialysate OUE=1 equates to a Kt/V = 1.2.
Author Affiliations and Disclosures: 1Dialysis from the Sharp End of the Needle and Carpenter's Union, Seattle Local 131; disclosed conflicts of interest, the author grows asparagus in his home garden. 2Dialysis from the Sharp End of the Needle and 1199 SEIU; disclosed conflicts of interest - too many to elaborate. 3This study would like thank the Stockton Asparagus Festival for funding; the authors report they declined a research grant offered by the Salt Institute after DESN's Internal Review Board determined an excessive use of NaCl as required by the grantor would be harmful to the health of the participants. 4This study would like thank Asparaguisetm for funding; Asparaguisetm the soy based asparagus replacement that tastes and looks like asparagus but dose not produce the asparagus cacosmia solute.
Keywords: Asparagus Odor, Asparagus Pee, Hemodialysis
Received for publication: 30. 3.09
Accepted in revised form: 31. 3.09
Further study will be required to identify the compound responsible for the olfactory response among the panelists. It should be noted that the decrease in OUE over dialysis treatment duration seems to track known urea removal rates which are highest during the first hour of treatment and then decline. This suggests that OUE measures could be used in situations where measuring pre and post BUN is not practicable.
Should dialysis units include identification and training of volunteer olfactometer panels as part of their emergency preparation? Each provider will have to make that decision on their own as the new Conditions for Coverage (http://www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp) are completely silent on the subject.
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Should dialysis units include identification and training of volunteer olfactometer panels as part of their emergency preparation?
Yes. And they should charge Medicare $400.00 per incident. :o
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Awesome, I think!
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:clap; :rofl; Is the official publication date of this April 1?
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:rofl; Hilarious!
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You slay me.
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Sounds like a joke to me. Not absolutely sure, but pretty sure.April fools?
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He got me - I am still researching his abstract. ;D
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:rofl; :rofl; :rofl;
Okay blond moment
Got me too! :2thumbsup;
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I am so gullible!! Good one!! :clap; :rofl;
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Got me right in the funny bone and I'm still cracking up Bill and Anna. I've read somewhere that not all people can actually smell the asparagus urine smell. Something to do with genetics.
We could do a poll right here. Who can smell asparagus in their urine?
I can big time, but love the stuff anyway (especially baked with olive oil and then sprinkled with a little parmesan cheese.)
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Who can smell asparagus in their urine?
The smell was awful, so I pulled out my kidneys.
8)
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I actually did an experiment Sunday night. I had asparagus for dinner and then that night once I was on dialysis I ran the drain line into a jar for a minute. The used dialysate totally had the asparagus pee smell. It's very distinctive.
But the abstract is completely made up to mock abstracts (and myself).
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I always thought the research showed that some people make the smelly compound and others don't. But, here's what wikipedia has to say about it (way to go Monrein :bow;)
"Observational evidence from the 1950s showed that many people did not know about the phenomenon of asparagus urine. There is debate about whether all (or only some) people produce the smell, and whether all (or only some) people identify the smell.
It was originally thought this was because some of the population digested asparagus differently than others, so that some people excreted odorous urine after eating asparagus, and others did not. However, in the 1980s three studies from France, China and Israel published results showing that producing odorous urine from asparagus was a universal human characteristic. The Israeli study found that from their 307 subjects all of those who could smell 'asparagus urine' could detect it in the urine of anyone who had eaten asparagus, even if the person who produced it could not detect it himself. Thus, it is now believed that most people produce the odorous compounds after eating asparagus, but only about 22% of the population have the autosomal genes required to smell them."
I love my asparagus grilled.
I've always been amazed how little asparagus it takes to make my pee fragrant.