Patent Application
20210302351
The present invention pertains to the medical field, particularly to the detection of potassium in clinical samples by using potentiometric sensors. More particularly, the present invention solves the problem of providing devices for measuring potassium, preferably in a single undiluted whole blood drop out of the clinical laboratory.
In the diagnosis and treatment of various diseases as well as in preventative health checkups, it is becoming increasingly important to monitor the concentrations of certain ions (e.g. cations) in a patient's body. One cation which has merited considerable attention is potassium. High serum potassium levels are known to cause changes in muscle irritability, respiration and myocardial functions. Low potassium levels can cause excitatory changes in muscle irritability and myocardial function. Therefore, serum potassium determination has become an important diagnostic tool when extremely high or low serum potassium levels are suspected.
One type of ion-selective electrode useful in determining ion concentration in body fluids has an electrode body (usually a glass or plastic container) containing a reference solution in contact with a half-cell of known potential (a reference electrode) and an ion-selective membrane located in an aperture in the electrode body. The ion-selective membrane is mounted in such a fashion that, when the electrode is immersed in the unknown solution, the membrane contacts both the reference and unknown solutions. A metal probe coated with a layer of insoluble salt of the metal in the reference solution and immersed therein serves as one of the contacts for measuring the potential between the electrodes and provides a reference potential for the electrode. The sensitivity of the electrode to an ion in solution is determined by the composition of the membrane. This type of electrode is referred to in the art as a “barrel” electrode.
The ion-selective membranes in barrel electrodes may be comprised of glass, solid salt precipitates or polymers. The polymeric membranes generally comprise a polymeric binder or support as the supporting matrix which is impregnated with a solution of an ion-selective carrier in a carrier solvent. The ion-selective carrier is a compound which is capable of sequentially complexing the desired ion and transporting the ion across the membrane-solution interface. This compound is also referred to in the art as an “ionophore” or “ion carrier”. Depending upon the ionophore, solvent and binder, membranes of this type can be used to detect a particular ion preferentially to other ions which may be in the solution.
Carrier solvents useful in ion-selective membranes must exhibit certain properties. The carrier solvents must provide suitable ion mobility in the membranes, be compatible with the supporting matrix and be sufficiently hydrophilic to permit rapid wetting of the membrane by aqueous solutions but sufficiently water-insoluble to inhibit leaching out into those aqueous solutions. Ideally, they also plasticize the supporting matrix and are substantially nonvolatile, thereby providing extended shelf life for the membrane.
A significant advance in the ion-selective-electrode art is the dry-operative electrode described in U.S. Pat. No. 4,214,968 (issued Jul. 29, 1980 to Battaglia et al). Prior to the discovery of such dry-operative ion-selective electrodes, electrodes had to be either stored in an aqueous solution or treated with aqueous solution just prior to use in an ion-activity-determining operation. The term “dry-operative” refers to an ion-selective electrode which provides reproducible potentiometric determination of ion activity which is related to the ion concentration of an aqueous test solution with no requirement for wet storage or preconditioning prior to use.
One of the specific ion-selective electrodes disclosed in the examples of Battaglia et al is a potassium ion-selective electrode using valinomycin as the potassium-selective ionophore dissolved in a variety of solvating compounds. Among useful solvents mentioned are phthalates, sebacates, aromatic and aliphatic ethers, phosphates, mixed aromatic aliphatic phosphates, adipates and mixtures thereof. In the potassium-selective electrodes utilizing valinomycin as the ionophore, particularly preferred carrier solvents disclosed are bromophenyl phenyl ether and certain trimellitates.
Dry-operative ion-selective electrodes are also described in Fuji's Japanese Patent Publication Nos. 17851/1982 and 17852/1982, both published Jan. 29, 1982. In the first example of each publication, a K+-selective electrode containing valinomycin, poly(vinyl chloride) and dioctyl phthalate as the carrier solvent. However, it has been observed that an electrode prepared using dioctyl phthalate as the carrier solvent exhibited poor precision in potassium ion determinations under certain conditions of use.
Further, it has been found that potassium ion-selective membranes and electrodes containing the membranes which are prepared according to the teaching of the Battaglia et al patent using the preferred carrier solvents taught therein (e.g. triisodecyl trimellitate), also exhibit undesirably poor precision in potassium ion determinations under certain conditions of use. It has also been observed that such membranes and electrodes are often sensitive to ambient temperature fluctuations thereby worsening precision in assay results. This poor precision worsens with extended storage.
On the other hand, blood potassium concentration is closely regulated by the body maintaining the potassium levels between 3.5 to 5.5 mM. However, potassium disorders are common, and severe cases can have fatal consequences. Potassium concentrations lower than 3.5 mM are known as hypokalemia and higher than 5.5 mM as hyperkalemia, and both conditions can lead to arrhythmias or a cardiac arrest in extreme conditions. 10% of the patients taking angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) used for the treatment of hypertension and congestive heart failure might develop hyperkalemia. Moreover, these drugs are therapeutically indicated for patients with renal insufficiency and diabetes which are at higher risk because of the inherent complications of their diseases. 27% of deaths in patients requiring hemodialysis are caused by arrhythmic problems. Although it is proven that continuous monitoring of potassium levels on these patients reduce their risk of suffering hyperkalemia, this is not a common practice and it depends mainly on the healthcare structure. Immediate potassium measurements, as well as continuous monitoring of potassium, may therefore contribute to improve patients care. Such issues may be covered by point-of-care devices (POC) which potential interest grows exponentially over the last decade. First, POC are particularly relevant when the turnaround time to get the result is crucial for the medical decision. Second and most importantly, POC overcome the problem of centralization of clinical analysis, i.e. for measurements outside the medical facilities either by the same patients (homecare) or by the medical professionals in situations such as emergency home visits, doctor's offices in remote areas, etc. Measuring potassium in such conditions may be very useful in emergency facilities to discard life-threatening conditions for patient suffering from chronic kidney disease (CKD) and cardiovascular diseases. In addition, potassium-POC could not only be beneficial for acute conditions but also for managing chronic diseases, where the continuous monitoring of biomarkers may help to prevent critical situations by giving relevant insights to the doctors to support clinical decisions. In this way, several studies revealed that abnormal potassium values are connected to higher mortality.
Several POC devices for measuring biomarkers including potassium are in the market, however, as far as we know, there are no POC devices which required a volume of a biological sample of less than 90 microliters capable of measuring potassium in a single whole blood drop out of the clinical laboratory.
Thus, the objective of this invention is to provide a POC by comparison with the reference technique used in the central laboratory of a hospital, capable of measuring potassium, by using a small volume of a single whole blood drop out of the clinical laboratory.
In accordance with this invention, it has been found that certain ion-selective compositions exhibit high selectivity for potassium ions over other cations in a sample specimen such as whole blood, sweat or saliva as well as unexpected improved precision in potassium ion determinations. In particular, it has been found that ion-selective compositions or membranes comprising (ISM) between 1.5 and 2.4 mg of Valinomycin, between 0.4 and 0.6 mg of potassium Tetrakis (4-chlorophenyl) borate (KTFPB), between 52.48 and 78.72 mg of Poly(vinylchloride) (PVC), and between 103.52 and 155.28 mg of Bis(2-ethylhexyl) sebacate (DOS) dissolved in a carrier solvent such as 1 mL of THF (Tetrahydrofuran), exhibit improved precision in potassium ion determinations. Further, these compositions exhibit these improved properties over a long period of time and therefore have greater shelf life.
The present invention solves the problem of providing devices for measuring potassium, preferably in a single undiluted whole blood drop out of the clinical laboratory.
In particular, a first aspect of the present invention provides for a potassium ion-selective membrane (ISM) comprising a composition which in turn comprises between 1.5 and 2.4 mg of Valinomycin, between 0.4 and 0.6 mg of potassium, lithium, ammonium or cessium Tetrakis (4-chlorophenyl) borate, between 52.48 and 78.72 mg of Poly(vinylchloride) (PVC), preferably such PVC has a molecular weight between 50000-250000 g/mol, more preferably between 70000-150000 g/mol, and between 103.52 and 155.28 mg of Bis(2-ethylhexyl) sebacate (DOS), (from hereinafter this composition shall be referred to as “PVC 2”) dissolved in a suitable carrier solvent such as 1 mL of THF (Tetrahydrofuran) or in any organic solvent capable of dissolving these components such as DMF. As shown in the examples (see example 1, preferably section 1.2 of example 1) such PVC 2 composition dissolved in a suitable carrier exhibited improved precision in potassium ion determinations. Further, this composition exhibited such improved properties over a long period of time and had an extended shelf life.
It is herein noted, that all of the above mentioned quantitative references of each of the components of the PVC 2 composition are expressed in weight per 1 ml of carrier solvent.
Preferably, the potassium ion-selective membrane (ISM) comprises or consists of between 1.8 and 2.2 mg/ml of Valinomycin, between 0.45 and 0.55 mg/ml of potassium, lithium, ammonium or cessium Tetrakis (4-chlorophenyl) borate, between 59.04 and 72.16 mg/ml of Poly(vinylchloride) (PVC), preferably such PVC has a molecular weight between 50000-250000 g/mol, and between 116.46 and 142.34 mg/ml of Bis(2-ethylhexyl) sebacate (DOS), dissolved in a suitable carrier solvent such as THF (Tetrahydrofuran).
It is noted that an ion-selective membrane comprising composition PVC 2 can be formed by incorporating the carrier solvent and each of the components of PVC 2 as described in example 1. In addition, a working electrode of a device capable of selectively measuring potassium can be prepared by using the above mentioned ion-selective membrane; namely, for this purpose, a conductive material such as carbon-ink, silver, Zinc or gold, or any other material that is capable of transducing the potentiometric signal, can be deposited on one side of a substrate, such as, but not limited to, paper or filter paper, plastic, rubber, textile or carbon filter, to create a conductive surface. Such treated substrate, such as paper, can be then cut into strips or into any other geometrical shape. To build the electrodes, the conductive substrate strips can be sandwiched within two masks. The top mask should have a, preferably circular, window to expose the electroactive surface, where the corresponding membrane can be drop cast (see
Therefore, in a preferred embodiment of the first aspect, the invention refers to a working electrode, that preferably forms part of a device capable of selectively measuring potassium, that comprises an ion-selective membrane comprising composition PVC 2 dissolved in a suitable carrier solvent such as those referred to hereinabove.
In addition, in a second aspect, the present invention provides for a reference membrane comprising a composition which in turn comprises between 8 and 12 mg of sodium chloride, preferably between 9 and 11 mg of sodium chloride, more preferably about 10 mg of sodium chloride, and between 94.88 mg and 142.32 mg of Butvar B-98, preferably between 106.74 mg and 130.46 mg of Butvar B-98, still more preferably about 118.6 mg of Butvar B-98 (PVB) (from hereinafter this composition shall be referred to as “PVB2”), dissolved in an appropriate solvent such as 1 mL of methanol. This cocktail can be stored at ambient temperature and will remain stable for more than 2 months. It is noted that PVB or Butvar B-98 is is understood as polyvinyl butyryl having a molecular weight between 40000-70000 g/mol with butyryl content between 78 and 80% weight per total weight of the polyvinyl butyryl (w/w), hydroxyl content between 18 and 20% (w/w) and acetate less than 2.5%, preferably between 1.5 and 2.5% (w/w).
It is herein noted, that all of the above mentioned quantitative references of each of the components of the PVB2 composition are expressed in weight per 1 ml of carrier solvent.
Such reference membrane composition can be formed by incorporating the carrier solvent and each of the above mentioned components as described in example 1. In particular, for the reference electrode of the potassium sensor to be prepared, a conductive material such as Ag/AgCl ink, preferably cured for about 10 minutes at about 90° C., can be deposited on one side of a substrate, such as paper or filter paper, plastic, rubber, textile or carbon filter, to create a conductive surface. Such treated substrate, such as paper, can be then cut into strips or into any other geometrical shape. To build the electrode, the conductive substrate strips can be sandwiched within two masks. The top mask has a circular window to expose the electroactive surface, where the corresponding membrane can be drop cast (see
Therefore, in a preferred embodiment of the second aspect, the invention refers to a reference electrode, that preferably forms part of a device capable of selectively measuring potassium, comprising composition PVB2 dissolved in a suitable carrier solvent such as referred to hereinabove.
The membrane compositions useful in this invention preferably have a glass transition temperature (Tg) of greater than about −50° C. in order to have desired film characteristics. Tg can be determined by any convenient method suitable for this purpose. For example, one such method is differential scanning calorimetry, as described in Techniques and Methods of Polymer Evaluation, Vol. 2, Marcel Dekker, Inc., N.Y. 1970. Preferably, the membranes have a Tg in the range of from about −50 to about −20° C.
The membranes useful in the present invention contain the described components over the specific range of concentrations or coverages specified above or below. The carrier solvent should be present in an amount sufficient to solvate the membrane compositions. The amount therefore depends on the particular solvent chosen. Generally, more solvent is used than is necessary to solvate the ion-selective membrane so that it remains solvated under a variety of storage conditions.
In addition to the membrane compositions, and carrier solvents, the described membrane compositions optionally contain other components such as surfactants and plasticizers in amounts known to those skilled in the art. As noted, surfactants are useful components of the described membranes. The surfactants serve a variety of functions including improving the coatability of the membrane composition and improving the solvation of valinomycin by the binder or carrier solvent. Useful surfactants include nonionic surfactants such as the alkylaryl polyether alcohols (Tritons™) available from Rohm and Haas Co; (p-isononylphenoxy)-polyglycidol (Surfactant 10G™) available from Olin Mathieson Corp; polyoxyethylene (20) oleyl ether (Brij 98™), polyoxyethylene sorbitan monolaurate (Tween 20™) and Span 80™, all available from Atlas Chemical Industries; poly(dimethyl-comethylphenyl siloxane) (DC-510™) available from Dow Corning; Zonyl FSN™ available from E. I. duPont; and fluorochemical surfactant FC134™ available from 3M Co.
It is noted that, as described in the examples of the present specification, comparison between the reference electrode PVB2 with a conventional reference electrode (PVB1) for the detection of potassium, provides for an experimental reproducibility of 100%, which compared with the reproducibility obtained of 30% achieved with the electrode composition (PVB1), constitutes a considerable success.
The key factor to improve the electrode construction reproducibility of PVB2 was the dispersion of sodium chloride in the polymeric matrix composed of PVB in methanol. In this way, the composition was optimized in 10 fold to reach a suitable dispersion which was stable in time. For this, the amount of salts was significantly reduced five-fold whereas the polymer amount was multiplied by 1.5 in comparison to the composition of PVB1. The former, is of particular interest so that the deposition of the reference membrane cocktail could be performed by conventional methods such as drop casting, or spin coating, in a way in which the electrode could be prepared in an automatized manner. It is, however, noted that further reference membranes different from composition PVB2 can also be used in combination with the ion-selective membrane of the invention, PCV 2, providing an improved potentiometric cell. In this sense, such further reference membranes are required to be capable of having ionic conduction, based on either solid salts such as sodium chloride or liquid salts such as ionic liquids, entrapped in a polymeric matrix, either PVB, PVC with or without a plasticizer. The resulting component can be dissolved in suitable organic solvents such as THF or Methanol.
Ideally, the further reference membranes should not provide a response to any of the species that are contained in the tested sample to measure but should preferably provide an immediate stabilization time. Therefore, when measuring in blood, an important parameter to be considered is the response of the sensor to proteins such as albumin, such response should be as low as possible.
The reference membranes useful in the present inventions should thus not display response to ions but show stabilization time in different orders of magnitude (from a few seconds to hours), and different responses to albumin. Depending on the application, one may select the more suitable membrane to fit the analytical requirements.
For measuring potassium, preferably in a single undiluted whole blood drop out of the clinical laboratory, reference membranes such as PVC 3 and PVC 4 (see table below) are particularly preferred since such membranes show an immediate stabilization time in comparison to PVB 3 and PVB 4 (see table below), while they show almost no response to albumin in comparison to reference membranes such as PVC 1.
It is noted that, in this context, “PVC” is understood as a poly(vinyl chloride) having a molecular weight between 22000-233000 g/mol.
In this context, a “plasticizer” is any liquid added to the membrane to make it softer and more flexible. Optimum plasticizers allow for the membrane to have optimum physical properties and ensures relatively high mobilities of their constituents. Examples of plasticizers are exemplified herein below:
In the context of the present invention, “IL” is understood as any ionic liquid, preferably an imidazolium substituted with alkyl chains in positions 1 and 3. Being R1 any alkyl between 1 to 3 carbons, and R2 between 2 to 12 carbons, with any lipophilic counter anion.
Therefore, in another preferred embodiment of the second aspect, the invention refers to a reference electrode, that preferably forms part of a device capable of selectively measuring potassium, comprising between 20 and 60 mg of 1-butyl-3-methylimidazolium bis(trifluoromethane sulfonyl)amide, and between 20 mg and 60 mg of poly(vinyl chloride) having a molecular weight between 22.000-23.3000 g/mol, dissolved in an appropriate solvent such as 1 mL of THF (Tetrahydrofuran), wherein the device preferably further comprises an ion-selective membrane comprising composition PVC 2 dissolved in a suitable solvent as described hereinabove. Preferably, such device is a potentiometric cell capable of selectively measuring potassium.
In another preferred embodiment of the second aspect, the invention refers to a reference electrode, that preferably forms part of a device capable of selectively measuring potassium, comprising between 8 and 12 mg of sodium chloride, and between 94.88 mg and 142.32 mg of Butvar B-98, dissolved in an appropriate solvent such as 1 mL of methanol, wherein the device preferably further comprises an ion-selective membrane comprising composition PVC 2 dissolved in a suitable solvent as described hereinabove. Preferably, such device is a potentiometric cell capable of selectively measuring potassium.
In another preferred embodiment of the second aspect, the invention refers to a reference electrode, that preferably forms part of a device capable of selectively measuring potassium, comprising between 9 and 11 mg of sodium chloride, and between 106.74 mg and 130.46 mg of Butvar B-98, dissolved in an appropriate solvent such as 1 mL of methanol, wherein the device preferably further comprises an ion-selective membrane comprising composition PVC 2 dissolved in a suitable solvent as described hereinabove. Preferably, such device is a potentiometric cell capable of selectively measuring potassium.
In another preferred embodiment of the second aspect, the invention refers to a reference electrode, that preferably forms part of a device capable of selectively measuring potassium, comprising between 20 and 90 mg of Bis(2-ethylhexyl) sebacate) (DOS), between 20 mg and 110 mg of Butvar B-98, and between 20 mg and 90 mg of 1-Hexyl-3-methylimidazolium tris(pentafluoroethyl)trifluorophosphate dissolved in an appropriate solvent such as 1 mL of THF (Tetrahydrofuran), wherein the device preferably further comprises an ion-selective membrane comprising composition PVC 2 dissolved in a suitable solvent as described hereinabove. Preferably, such device is a potentiometric cell capable of selectively measuring potassium.
In another preferred embodiment of the second aspect, the invention refers to a reference electrode, that preferably forms part of a device capable of selectively measuring potassium, comprising between 25 and 30 mg of 1-butyl-3-methylimidazolium bis(trifluoromethane sulfonyl)amide, and between 50 mg and 60 mg of poly(vinyl chloride) having a molecular weight between 22.000-23.3000 g/mol, dissolved in an appropriate solvent such as 1 mL of THF (Tetrahydrofuran), wherein the device preferably further comprises an ion-selective membrane comprising composition PVC 2 dissolved in a suitable solvent as described hereinabove. Preferably, such device is a potentiometric cell capable of selectively measuring potassium.
In another preferred embodiment of the second aspect, the invention refers to a reference electrode, that preferably forms part of a device capable of selectively measuring potassium, comprising between 50 and 60 mg of 1-butyl-3-methylimidazolium bis(trifluoromethane sulfonyl)amide, and between 25 mg and 30 mg of poly(vinyl chloride) having a molecular weight between 22.000-23.3000 g/mol, dissolved in an appropriate solvent such as 1 mL of THF (Tetrahydrofuran), wherein the device preferably further comprises an ion-selective membrane comprising composition PVC 2 dissolved in a suitable solvent as described hereinabove. Preferably, such device is a potentiometric cell capable of selectively measuring potassium.
In another preferred embodiment of the second aspect, the invention refers to a reference electrode, that preferably forms part of a device capable of selectively measuring potassium, comprising between 55 and 65 mg of Bis(2-ethylhexyl) sebacate) (DOS), between 25 mg and 35 mg of Butvar B-98, and between 35 mg and 45 mg of 1-Hexyl-3-methylimidazolium tris(pentafluoroethyl)trifluorophosphate dissolved in an appropriate solvent such as 1 mL of THF (Tetrahydrofuran), wherein the device preferably further comprises an ion-selective membrane comprising composition PVC 2 dissolved in a suitable solvent as described hereinabove. Preferably, such device is a potentiometric cell capable of selectively measuring potassium.
On the basis of the above, a further aspect of the invention, a third aspect, refers to a device, preferably a POC device, capable of measuring potassium, preferably in a single whole blood drop out of the clinical laboratory, made by combining any of the above mentioned reference membranes (reference is made to the second aspect of the invention or to any of its preferred embodiments) and the ion-selective membrane described in the first aspect of the invention, PVC 2, thus resulting in a whole potentiometric cell. Preferably such whole potentiometric cell is connected to an instrument for EMF reading and the data read through a tablet with the suitable software interface.
In a particularly preferred embodiment, the described membranes are used to provide a potassium ion-selective electrode or potentiometric cell comprising:
As already mentioned, in a fourth aspect, the electrodes of this invention can be used to determine the concentration of potassium in an aqueous solution, e.g. biological fluids such as whole blood, preferably undiluted whole blood, intracellular fluids, blood sera, blood plasma, sweat and urine. Generally, a portion of the solution to be assayed is brought into contact with the ion-selective electrode described hereinabove which is capable of making potentiometric measurements related to the potassium ion concentration. Subsequently, the difference in potential between the portion of aqueous solution and the reference electrode is measured. Preferably, a drop of the aqueous solution is spotted onto the potassium ion-selective membrane of such electrode with a pipette or other suitable means, but other ways of contacting the electrode with the solution are acceptable.
In addition, the authors of the present invention validated the performance of a POC device capable of measuring potassium as described in the third aspect in undiluted whole blood samples. To do so, the correlation of the results obtained by the POC were compared to the results obtained by the ADVIA Chemistry XPT system. Passing-Bablock regression and Blant-Altman analysis confirmed that there is a strong correlation between the results obtained by both methodologies with a small bias and limits of agreement in −0.62 and 0.68 mM (
The higher contribution to the variability of the technique comes from the precision of the sensor (0.25 mM). Other parameters such as the manual calibration or some interferences from blood may contribute to the remaining variability. The main issue that affects the potassium measurements in blood is the hemolysis of the sample, i.e. as the erythrocytes are broken, their intracellular components are released into the blood and as the intracellular potassium concentration is highly superior to the plasmatic one, this leads to misleading results (highly elevated concentration). As the samples where measured first with the ADVIA Chemistry XPT system in plasma and later homogenized and measured in blood with the POC, some of the abnormal higher potassium values could be coming from some grade of hemolysis of the blood. Another parameter that has to be considered is that the ADVIA Chemistry XPT system measures with indirect ion selective electrodes in a pre-diluted sample, while the POC device measures with direct ISEs in whole blood. Lipemia in serum causes a reduction in the aqueous fraction leading to abnormal lower values, which does not happen in the whole blood measurements. This may be an additional source of variation between the two methodologies. Since the overall results highly correlate with the reference technique, it was concluded that the possible interferences were not affecting significantly the results here.
Once validated the measurement, the advantages and limitations of the POC versus a reference technique must be considered. This point-of-care device is not conceived to compete with the reference technique in the healthcare facility, but rather to complement the conventional analysis by giving an immediate response when required. Although the value is less precise, it may have a great impact when discarding life-threatening conditions. Hence, some of the classical parameters may have less importance than other ones. In this way, conventional parameters such as sensitivity, limit of detection and linear range are comparable in both techniques. Precision for the POC is good enough for the situations for which is intended to be used. In the same way, the cost per analysis may be higher with the POC device in the first step, but, as mentioned previously, the immediate response may reduce strongly indirect related costs. It may have huge impact on the early detection of several medical conditions that will avoid future problems and complications in the patient health, eventually reducing the costs of the treatment.
The POC meets the requirement for direct analysis since it uses a small amount of blood and that no pre-treatment is performed. The POC presents the benefits that this implies, especially the reduction of the time between the sample withdraw from the patient and the given result. This POC has the particular advantage to work with paper-based sensors, which are extremely cheap and suitable for scaling production. No contamination neither fouling of the membrane are observed in such conditions.
This invention thus clearly illustrates the usefulness of the POC devices according to the third aspect of the invention in a real scenario (outside the laboratory), validating the potassium measurements in comparison with a reference technique. Consequently, the point-of-care potassium device of the present invention has demonstrated an excellent correlation with the reference method for patients on dialysis, showing that there is a strong correlation between the point-of-care (POC) device and the reference method (R2=0.968). Bland-Altman analysis shows no bias between the two methods and revels that 95.5% confidence intervals are between −0.62 to 0.68 mM. No significant interferences have been detected due to the measurement of potassium in total blood compared to its conventional measurement in serum.
The following examples are merely presented to illustrate the practice of this invention.
1. Material & Methods
Whatman® Grade 5 qualitative filter paper was used for the fabrication of the electrodes. All chemicals were purchased from Sigma-Aldrich. All solutions were prepared using 18.2 MΩ cm1 double deionized water (Milli-Q water systems, Merck Millipore). Butvar B-98 (PVB) was obtained from Quimidroga S.A. (Barcelona, Spain). Plastic mask (Arcare 8565) were provided by Adhesives Research Inc., Limerick, Ireland. Carbon-ink and Silver/silver chloride (Ag/AgCl) ink was purchased from Creative Materials Inc. (Massachusetts, USA).
Electrode Geometry
As a first step, the preparation of the paper used as a substrate was performed. For the working electrodes, a carbon-ink was deposited on one side of the filter paper to create a conductive, surface. For the reference electrode, a filter paper was first painted with a conductive Ag/AgCl ink and cured for 10 minutes at 90° C.
These treated papers were then cut into 10×5 mm strips. To build the electrodes, the conductive paper strips were sandwiched within two plastic masks. The top mask has a circular window of 3 mm diameter to expose the electroactive surface, where the corresponding membrane (either for the working or for the reference) was drop cast (see
Working Electrode Composition (PVC 2):
A potassium ion selective membrane (ISM) (from hereinafter PVC 2) containing 2 mg of Valinomycin, 0.5 mg of potassium Tetrakis (4-chlorophenyl) borate (KTFPB), 65.6 mg of Poly(vinylchloride) (PVC), and 129.4 mg of Bis(2-ethylhexyl) sebacate (DOS) was dissolved in 1 mL of THF. The cocktail was then stored at 4° C. and remained stable for more than 2 weeks.
Reference Electrode Composition (PVB2):
The reference membrane (from hereinafter PVB2) contained 10 mg of sodium chloride and 118.6 mg of Butvar B-98 (PVB). The membrane was prepared by dissolving the components in 1 mL of methanol. The cocktail was stored at ambient temperature and remained stable for more than 2 months.
Deposition of the Cocktail:
Potassium electrodes were prepared by drop-casting 15 μL of the membrane (in 3 drops of 5 μL, waiting for 2 minutes between each drop) in an orifice of 3 mm (see
Reference electrodes were prepared by depositing 5 mg of sodium chloride in the orifice (3 mm) and then drop-casting 30 μL of the reference membrane (in 3 consecutive drops of 10 μL, waiting for 5 minutes between each drop) (see
Conditioning of the Electrodes
Reference electrode: 18 hours in a KCl 0.01 M before use.
Working electrode: no conditioning was required
2. Comparison Between Working Electrode as Described Above (See Materials and Methods) with Conventional Working Electrodes for the Detection of Potassium
Conventional working electrodes for potassium detection have been reported as Si, PU and PVC 1, where Si, Pu and PVC1 states for Silicon rubber, Polyurethane and Polyvinylchloride polymer respectively (please refer to the table below for the precise composition of each of these electrodes). However, Si has the disadvantage of displaying substantial instrumental noise in the time trace so that additional signal treatment would be necessary for the use of this membrane in real whole blood samples (see
Pu-based sensors have relatively good performance in water (see figures) although this performance is drastically reduced when artificial serum is used. In fact, two orders of magnitude are lost in the linear range when artificial serum is used instead of water (from −6 (mM) to −2 (mM) and from −4 (mM) to −2 (mM) for water and artificial serum respectively). In addition, the Limit of detection for Pu-based sensors is decreased from −6.5 (log [K+]/M) down to −5 (log [K+]/M) as well as the sensitivity from 57.2 down to 53.2 mv/dec when artificial serum is used instead of water. For these reasons, the PU-based electrodes were also discarded for measuring potassium in a single undiluted whole blood drop out of a clinical laboratory since such Limits of detection are insufficient for reliably detecting potassium in undiluted whole blood.
In addition, PVC 1 also suffers a drastic reduction of performance from water to artificial serum measurements (two orders of magnitude less, a LOD decrease to −4.5 (log [K+]/M) and a sensitivity down to 54 mv/dec). PVC 1 was also thus discarded for whole blood detection (see figures).
However, PVC 2 composition allows detecting potassium in artificial serum with better performance (see figures). The Sensitivity is the highest reported of the tested sensors (55.7 mV/dec in artificial serum). The linear range is only reduced by one order of magnitude (which is sufficient for the targeted application) with a limit of detection of −5.6 (log [K+]/M). Therefore, working electrode composition PVC 2 provides a substantial improvement over known working electrode compositions for undiluted whole blood measurement.
3. Comparison Between the Reference Electrode PVB2 with a Conventional Reference Electrode for the Detection of Potassium
The reference electrode composition described in the materials and methods above-mentioned containing sodium chloride (NaCl) and polymer (polyvinylButyral, PVB) provided for an experimental reproducibility of 100%, which compared with the reproducibility obtained of 30% achieved with a previously reported electrode composition (PVB1), constitutes a considerable success.
The key factor to improve the electrode construction reproducibility of PVB2 was the dispersion of NaCl in the polymeric matrix composed of PVB in methanol. In this way, the composition was optimized in order to reach a suitable dispersion stable in time. For this, the amount of salts was significantly reduced fivefold whereas the polymer amount was multiplied by 1.5 in comparison to the composition of PVB1. The former, is of particular interest so that the deposition of the reference membrane cocktail could be performed by conventional methods such as drop casting, spin coating etc. . . . so that the electrode could be prepared in an automatized manner.
The selected composition of PVB2 thus affords a suitable dispersion of NaCl in the polymeric matrix, which in turn allows for an expected membrane formation on the substrate.
Materials and Methods
Patients and Samples
We selected 36 random patients undergoing dialysis in Hospital Clinic de Barcelona (27 men, 8 women, mean age 63±15). The underlying renal diseases were chronic glomerulonephritis in 9 patients, diabetic nephropathy in 4, polycystic kidney disease in 3, nephroangiosclerosis in 5, systemic diseases in 2, urologic disease in 3, chronic tubulo-interstitial nephritis in 3, and undiagnosed nephropathy in 6. All patients signed informed consent forms approved by the hospital's Research Committee. Whole-blood samples were collected in lithium heparin BD Vacutainer Tubes (Ref. 368884).
Methods Description
ADVIA Chemistry XPT from Siemens Healthineers was used as the reference system for the potassium measurement. ADVIA Chemistry XPT performs an indirect measurement (dilution 1:33) of potassium in plasma with ion selective electrodes technology.
The point-of-care device performs a direct measurement of potassium in whole blood with ion selective electrodes technology. The POC consists of a paper-based sensor (potassium ion selective and reference electrodes) connected to a miniaturized potentiometer. The potentiometer is at the same time connected to a portable device such as a Tablet or laptop with adequate software. The paper-based sensor is disposable and requires a two point calibration before every potassium measurement. This calibration is done with two standards of 1 mM and 10 mM potassium, so that the sample will always fall inside the calibration curve. After the calibration, the sensor is rinsed with water and the whole blood sample is directly measured. The software which records the potential of the two standards and the sample can directly predict the potassium concentration.
Study Design
The study was planned in a way in which potassium values will be scattered in the whole biological range, therefore the blood was extracted from the patients before and after the dialysis session during 10 sessions. Some of the patients miss one of the sessions due to clinical or management problems. Once the blood was extracted from the patient, the analysis of the samples followed the normal procedure of the hospital: the samples were sent to the central laboratory where they were introduced in the Aptio Automation System (AAS) (Siemens Healthineers) and automatically centrifuged (2000 g for 8 minutes) to obtain the plasma. Samples were analyzed in ADVIA Chemistry XPT system with a predilution of 1:33. After the result was obtained, the samples were recovered from the ASS, homogenized again and measured with the POC in the whole blood form.
Statistics
The results of the samples were analyzed by Passing-Bablock regression and Bland-Altman plots. Passing-Bablock regression calculates a regression equation (y=ax+b) including 95% confidence intervals for the constants. Bland-Altman plot analyzes the agreement between to different methods that measure the same variable by plotting the mean of the two methods versus its difference.
Results
The ADVIA Chemistry XPT analyzer and the POC have been compared not only in terms of the conventional analytical performance parameters, but also taking into account other parameters that gain a remarkable importance when dealing with in-situ analysis, such as the time of response and the sample volume. Table 1 displays a comparison of the selected parameters for the two methodologies.
Regarding the conventional analytical parameters, no significant difference was detected between both techniques. Indeed, the linear range is the same and although sensitivity and limit of detection are not reported for the ADVIA Chemistry XPT system probably they would be very similar since the fundamental detection technique is potentiometry in both cases. However, precision is one order of magnitude higher for the reference technique. Precision is analyzed in more depth below. The parameters displayed in the second part of the table represent relevant characteristic for POC and homecare. Noteworthy, the reference technique employs diluted plasma, which involves first a centrifugation followed by a proper dilution with a buffered solution. This feature implies a much higher required sample volume for the reference method (typically of a few mL, i.e. the conventional lithium heparin tubes used in this study for collecting venous blood are of 4 mL).
A total of 705 whole-blood samples were measured with the POC, and the corresponding serums with the ADVIA Chemistry XTP system. 11 of these samples were excluded from the analysis because of erroneous measurements. Passing-Bablock regression analysis was applied to the data and the results are shown in
A Bland-Altman (B&A) analysis of the data (
| Number | Date | Country | Kind |
|---|---|---|---|
| 18382582.7 | Jul 2018 | EP | regional |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2019/070657 | 7/31/2019 | WO | 00 |
