Estimation of clinical parameters of chronic kidney disease by exhaled breath full-scan mass spectrometry data and iterative PCA with intensity screening algorithm

Breath mass spectrometry is a useful tool for identifying important compounds associated with health. However, there have been few studies that have explored human exhaled breath by full-scan mass spectrometry as a non-invasive method for medical diagnosis, which may be attributed to the difficulties resulting from multicollinearity and small sample sizes relative to a large number of product ions. In this study, breath samples from 54 chronic kidney disease patients were analyzed by selected ion flow tube mass spectrometry in the full-scan mode. With the signal intensities of product ions, we developed a novel and robust algorithm, iterative PCA with intensity screening (IPS), to build linear models for estimating important clinical parameters of chronic kidney disease. It has been shown that IPS provided good estimations in cross-validated samples, and furthermore the identified product ions could have direct medical relevance to the disease. The study demonstrated the potential of quantitative breath analysis using mass spectrometry for medical diagnosis, and the importance of applying appropriate statistical tools to unveil the rich information in this type of data.

[1]  S. Geer,et al.  Correlated variables in regression: Clustering and sparse estimation , 2012, 1209.5908.

[2]  A. Manolis,et al.  The diagnostic potential of breath analysis. , 1983, Clinical chemistry.

[3]  Tianshu Wang,et al.  Generation of volatile compounds on mouth exposure to urea and sucrose: implications for exhaled breath analysis , 2006, Physiological measurement.

[4]  G. Rooth,et al.  Acetone in alveolar air, and the control of diabetes. , 1966, Lancet.

[5]  Keith C. Norris,et al.  Intensive blood-pressure control in hypertensive chronic kidney disease. , 2010, The New England journal of medicine.

[6]  Harald Martens,et al.  A multivariate calibration problem in analytical chemistry solved by partial least-squares models in latent variables , 1983 .

[7]  R. Shaker,et al.  The promise and perils of exhaled breath condensates. , 2004, American journal of physiology. Lung cellular and molecular physiology.

[8]  M. Phillips,et al.  Breath tests in medicine. , 1992, Scientific American.

[9]  I. Jolliffe Principal Component Analysis , 2002 .

[10]  S A Glantz,et al.  Multiple regression for physiological data analysis: the problem of multicollinearity. , 1985, The American journal of physiology.

[11]  David Smith,et al.  A longitudinal study of methanol in the exhaled breath of 30 healthy volunteers using selected ion flow tube mass spectrometry, SIFT-MS , 2006, Physiological measurement.

[12]  R. Keast,et al.  Taste changes and saliva composition in chronic kidney disease , 2012 .

[13]  K. Jindal,et al.  Percent reduction in blood urea concentration during hemodialysis (PRU). A simple and accurate method to estimate Kt/V urea. , 1987, ASAIO transactions.

[14]  Malina K. Storer,et al.  Use of a least absolute shrinkage and selection operator (LASSO) model to selected ion flow tube mass spectrometry (SIFT-MS) analysis of exhaled breath to predict the efficacy of dialysis: a pilot study , 2016, Journal of breath research.

[15]  Susan L Furth,et al.  New equations to estimate GFR in children with CKD. , 2009, Journal of the American Society of Nephrology : JASN.

[16]  A. Amann,et al.  Detection of potential chronic kidney disease markers in breath using gas chromatography with mass-spectral detection coupled with thermal desorption method. , 2013, Journal of chromatography. A.

[17]  W. W. Muir,et al.  Regression Diagnostics: Identifying Influential Data and Sources of Collinearity , 1980 .

[18]  A. Hansel,et al.  On-line monitoring of volatile organic compounds at pptv levels by means of proton-transfer-reaction mass spectrometry (PTR-MS) medical applications, food control and environmental research , 1998 .

[19]  Simone Meinardi,et al.  Breath ethanol and acetone as indicators of serum glucose levels: an initial report. , 2005, Diabetes technology & therapeutics.

[20]  Chris Jones,et al.  Decline in kidney function before and after nephrology referral and the effect on survival in moderate to advanced chronic kidney disease. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[21]  T. Ikizler,et al.  Association of morbidity with markers of nutrition and inflammation in chronic hemodialysis patients: a prospective study. , 1999, Kidney international.

[22]  M. Pelli,et al.  Effect of Two-Hour Daily Hemodialysis and Sham Dialysis on Breath Isoprene Exhalation , 2007, The International journal of artificial organs.

[23]  Wei Zhang,et al.  Tunable fiber laser based photoacoustic spectrometer for breath ammonia analysis during hemodialysis1 , 2012 .

[24]  V. Bierbaum,et al.  Chemical ionization mass spectrometric determination of acrolein in human breast cancer cells. , 2002, Analytical Biochemistry.

[25]  Abdullah Sener,et al.  Salivary Glucose Concentration and Excretion in Normal and Diabetic Subjects , 2009, Journal of biomedicine & biotechnology.

[26]  B Canaud,et al.  A simple and accurate method to determine equilibrated post-dialysis urea concentration. , 1997, Kidney international.

[27]  P. Martínez-Lozano,et al.  Electrospray ionization of volatiles in breath , 2007 .

[28]  P. Španěl,et al.  Ions in the terrestrial atmosphere and in interstellar clouds , 1995 .

[29]  Lin Sun,et al.  [Clinical significance of saliva urea, creatinine, and uric acid levels in patients with chronic kidney disease]. , 2012, Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences.

[30]  P. Zagrodzki,et al.  [New opportunities of renal diseases diagnostics using gas chromatography]. , 2012, Przeglad lekarski.

[31]  P. Knauf,et al.  Monthly publication in 1986 , 1985 .

[32]  P. Strickland,et al.  Multicollinearity may lead to artificial interaction: an example from a cross sectional study of biomarkers. , 1997, The Southeast Asian journal of tropical medicine and public health.

[33]  D. B. Milligan,et al.  Application of selected ion flow tube mass spectrometry to real-time atmospheric monitoring. , 2010, Rapid communications in mass spectrometry : RCM.

[34]  María Elena López,et al.  Salivary characteristics of diabetic children. , 2003, Brazilian dental journal.

[35]  Nicola Donato,et al.  Real-time monitoring of breath ammonia during haemodialysis: use of ion mobility spectrometry (IMS) and cavity ring-down spectroscopy (CRDS) techniques. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[36]  Song-min Huang,et al.  Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. , 2006, Journal of the American Society of Nephrology : JASN.

[37]  R. Cernat,et al.  Ethylene and ammonia traces measurements from the patients’ breath with renal failure via LPAS method , 2011 .

[38]  P. Fein,et al.  Markers for survival in dialysis: a seven-year prospective study. , 1995, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[39]  P. Španěl,et al.  A selected ion flow tube study of the reactions of NO+ and O+2 ions with some organic molecules: The potential for trace gas analysis of air , 1996 .

[40]  P. Spanĕl,et al.  Influence of water vapour on selected ion flow tube mass spectrometric analyses of trace gases in humid air and breath. , 2000, Rapid communications in mass spectrometry : RCM.

[41]  P. Spanĕl,et al.  Quantification of hydrogen sulphide in humid air by selected ion flow tube mass spectrometry. , 2000, Rapid communications in mass spectrometry : RCM.

[42]  R. Foley,et al.  Hypoalbuminemia, cardiac morbidity, and mortality in end-stage renal disease. , 1996, Journal of the American Society of Nephrology : JASN.

[43]  L R Narasimhan,et al.  Correlation of breath ammonia with blood urea nitrogen and creatinine during hemodialysis , 2001, Proceedings of the National Academy of Sciences of the United States of America.

[44]  P. Španěl,et al.  Quantitative analysis of ammonia on the breath of patients in end-stage renal failure. , 1997, Kidney international.

[45]  Raed A. Dweik,et al.  Analysis of breath volatile organic compounds as a noninvasive tool to diagnose nonalcoholic fatty liver disease in children , 2014, European journal of gastroenterology & hepatology.

[46]  Paul Geladi,et al.  Principal Component Analysis , 1987, Comprehensive Chemometrics.

[47]  David Smith,et al.  Selected ion flow tube mass spectrometry (SIFT-MS) for on-line trace gas analysis. , 2005, Mass spectrometry reviews.

[48]  P. Španěl,et al.  Selected ion flow tube: a technique for quantitative trace gas analysis of air and breath , 1996, Medical and Biological Engineering and Computing.

[49]  Malina K. Storer,et al.  Breath ammonia and trimethylamine allow real-time monitoring of haemodialysis efficacy , 2011, Physiological measurement.

[50]  M. Phillips,et al.  Increased breath biomarkers of oxidative stress in diabetes mellitus. , 2004, Clinica chimica acta; international journal of clinical chemistry.

[51]  R. Cataneo,et al.  Volatile organic compounds in breath as markers of lung cancer: a cross-sectional study , 1999, The Lancet.

[52]  P. Španěl,et al.  A new 'online' method to measure increased exhaled isoprene in end-stage renal failure. , 2001, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[53]  J. Covington,et al.  Breathomics—exhaled volatile organic compound analysis to detect hepatic encephalopathy: a pilot study , 2016, Journal of breath research.