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Hemodialysis International.... Oct 2017Solute removal performance of the dialyzer is closely related to physicochemical structures of the membrane. The objective of this study is to devise a new in vitro...
OBJECTIVE
Solute removal performance of the dialyzer is closely related to physicochemical structures of the membrane. The objective of this study is to devise a new in vitro evaluation technique to directly correlate the physicochemical structures of the membrane to the dialysis performance.
MATERIALS AND METHODS
Commercial 11 dialyzers with cellulose triacetate (CTA), ethylene vinylalcohol co-polymer (EVAL), asymmetry CTA (termed ATA), 4 polysulfone (PSf), polyether sulfone (PES), and 3 polyester polymer alloy (PEPA) membranes were employed for investigation. Normal dialysis experiments were performed with aqueous creatinine (MW 113), bromophenol blue (MW 670), vitamin B (MW 1355), chymotrypsin (MW 25,000) test solutions. Reversal dialysis experiments were devised introducing the test solution outside the hollow fiber (HF) and the dialysate inside the HF, respectively. Clearances were measured under Q = 200 mL/min and Q = 500 mL/min at 310 K. The ratio of clearance in the reversal dialysis to that in the normal dialysis termed the yielding factor of asymmetry, f , was defined for evaluation.
RESULTS AND DISCUSSION
According to the classic mass transfer theory, clearance in the normal dialysis and that in the reversal dialysis are expected to be identical; however, the average f was 0.96 for creatinine and was always slightly lower than unity in 10 dialyzers out of 11. This may be caused by un-uniform distribution of the test solution outside the HF, which was more likely to occur than when it flowed inside the HF. Unlike creatinine, the average f for vitamin B was 1.0 and that for chymotrypsin was 1.06 to 1.45 in membranes with heterogeneous structures (ATA, PSf, PEPA, and PES), but was almost unity (1.02) in homogeneous membrane (CTA). This must be based on the fact that the membrane permeability in the reversal dialysis is much larger than that in the normal dialysis due to the physicochemical structures of the heterogeneous membrane that has a wedge-like pore size distribution in the radial direction.
CONCLUSIONS
A wedge-like pore size distribution in the radial direction in heterogeneous membrane was semiquantitatively evaluated by introducing a reversal dialysis technique with a new index.
Topics: Chemical Phenomena; Dialysis Solutions; Humans; Membranes, Artificial; Renal Dialysis
PubMed: 29064175
DOI: 10.1111/hdi.12595 -
Journal of Renal Nutrition : the... Jan 2012Fibrosis and vascular sclerosis are main complications that limit the long-term application of peritoneal dialysis (PD). Low biocompatibility has been largely attributed... (Review)
Review
Fibrosis and vascular sclerosis are main complications that limit the long-term application of peritoneal dialysis (PD). Low biocompatibility has been largely attributed to the presence of glucose degradation products (GDPs), which are formed during the heat sterilization of PD fluids. GDPs readily modify proteins in the peritoneum, leading to a decline of their biological function. After absorption, GDPs can also promote systemic protein glycation. Additionally, GDPs may augment DNA glycation, a process enhanced in uremia. Apart from their glycating activity, GDPs induce cytotoxicity and interfere with cell signaling in peritoneal mesothelial cells. Targeted screening revealed the nature of the 6 major GDPs with α-dicarbonyl structure as 3-deoxyglucosone, 3-deoxygalactosone, glucosone, glyoxal, methylglyoxal, and 3,4-dideoxyglucosone-3-ene. Valid quantification of these GDPs was achieved by ultrahigh-performance liquid chromatography/diode array detector/tandem mass spectrometry. Identification and quantification of single GDPs allow a structure-dependent risk evaluation. As a consequence, PD fluids and processes can be improved to reduce the GDP burden of patients undergoing PD.
Topics: Deoxyglucose; Dialysis Solutions; Galactose; Glucose; Glyoxal; Hot Temperature; Humans; Ketoses; Peritoneal Dialysis; Pyrones; Structure-Activity Relationship
PubMed: 22200439
DOI: 10.1053/j.jrn.2011.10.014 -
Polskie Archiwum Medycyny Wewnetrznej Mar 2002
Review
Topics: Bandages; Dialysis Solutions; Humans; Peritoneal Dialysis; Urinary Catheterization
PubMed: 12107988
DOI: No ID Found -
Peritoneal Dialysis International :... 2000
Review
Topics: Automation; Biological Transport; Dialysis Solutions; Humans; Peritoneal Dialysis; Peritoneum; Pressure
PubMed: 10911649
DOI: No ID Found -
Advances in Renal Replacement Therapy Oct 2002Fluid composition and management are important parts of continuous renal replacement therapy (CRRT). Most commercially available CRRT solutions are able to reestablish... (Review)
Review
Fluid composition and management are important parts of continuous renal replacement therapy (CRRT). Most commercially available CRRT solutions are able to reestablish electrolyte homeostasis provided some phosphate supplementation is given. Supraphysiologic glucose concentrations should be avoided. Predilution fluid replacement allows higher ultrafiltration rates and can be considered as an adjunct to the anticoagulation regimen. Lactate is an effective buffer in most CRRT patients. Bicarbonate is preferred in patients with lactic acidosis and/or liver failure. When citrate is used as anticoagulant, frequent monitoring of pH is required. The clinical consequences of CRRT-induced decreases of body temperature are not clear. Substitution fluid should be sterile, but the bacteriologic requirements for CRRT dialysate are less clear. There is no consensus on the optimal parameters to monitor fluid management. Integrated balancing systems have theoretical advantages over adaptive use of intravenous fluid pumps. Although there is evidence that volume overload is associated with adverse outcome, there is no evidence that fluid removal per se improves outcome in critically ill patients with or without acute renal failure.
Topics: Buffers; Dialysis Solutions; Humans; Practice Guidelines as Topic; Quality Assurance, Health Care; Renal Dialysis
PubMed: 12382232
DOI: 10.1053/jarr.2002.35572 -
Peritoneal Dialysis International :... 2000To investigate the biocompatibility of "new" peritoneal dialysis (PD) solutions with bicarbonate/lactate buffer, non glucose osmotic agents (icodextrin or amino acids),... (Comparative Study)
Comparative Study
OBJECTIVE
To investigate the biocompatibility of "new" peritoneal dialysis (PD) solutions with bicarbonate/lactate buffer, non glucose osmotic agents (icodextrin or amino acids), neutral pH, and low levels of glucose degradation products (GDPs).
DESIGN
Using M199 culture medium as a control, we compared conventional and new PD solutions with respect to their effects on the viability of human peritoneal mesothelial cells (HPMCs) [using lactate dehydrogenase (LDH) release], on DNA damage in HPMCs [using single-cell gel electrophoresis (Comet assay)], and on HPMC proliferation (using [3H]-thymidine incorporation). The experiments were performed after cell growth was synchronized by incubation with serum-free media for 24 hours. The PD solutions tested included commercial 1.5% glucose and 4.25% glucose solutions with 40 mmol/L lactate (D 1.5 and D 4.25, respectively), 7.5% icodextrin (E), 1.1% amino acid (N), 1.5% glucose solution in a triple-chambered bag (Bio 1.5), 1.5% glucose solution in a dual-chambered bag with neutral pH (Bal 1.5), and 1.5% glucose and 4.25% glucose solution containing 25 mmol/L bicarbonate and 15 mmol/L lactate (P 1.5 and P 4.25, respectively).
RESULTS
When HPMCs were continuously exposed to undiluted PD solutions, D 1.5, D 4.25, P 4.25, and E increased LDH release by more than 60% at 24 hours. All PD solutions tested increased LDH release by more than 75% at 96 hours. With 2-fold diluted PD solutions, only D 4.25 significantly increased LDH release at 96 hours, though not at 24 hours. When cells were exposed to undiluted PD solutions for 60 min and allowed to recover in M199 for up to 96 hours, LDH release was significantly higher at 24-96 hours in E (55%-69%) and D 1.5 (48%-72%) as compared with control [M199 (18%)]. Release of LDH was significantly lower with PD solutions containing lower levels of GDPs than those in D 1.5, suggesting that GDPs may have a role in cell viability. The D solutions (D 1.5 and D 4.25) and E solution also induced significant DNA damage. Both LDH release and DNA damage by D and E were significantly attenuated by adjusting the solution pH to 7.4, suggesting that low pH may be implicated in PD solution-induced DNA damage and cell death. When diluted 2-fold, D 1.5, D 4.25, and P 4.25 decreased [3H]-thymidine incorporation to 43%, 34%, and 41% of control, respectively, at 24 hours and to 45%, 26%, and 35% of control, respectively, at 96 hours. When cells were exposed to undiluted PD solutions for 5 minutes and allowed to recover in M199 for up to 96 hours, D1.5 and P 4.25--but not D 4.25--significantly inhibited cell proliferation at 24 hours. This effect was sustained up to 96 hours.
CONCLUSIONS
The present in vitro data demonstrate that PD solutions with low pH, or high levels of GDPs, or both, promote HPMC death and DNA damage, and that PD solutions with high osmolality inhibit cell proliferation. Solutions with neutral pH, amino acids, and "low GDPs" appear to be more biocompatible than conventional PD solutions. These results require confirmation in in vivo animal and clinical studies.
Topics: Cell Division; Cell Survival; Cells, Cultured; Comet Assay; Culture Media; DNA; Dialysis Solutions; Epithelial Cells; Humans; Hydrogen-Ion Concentration; L-Lactate Dehydrogenase; Peritoneal Cavity; Peritoneal Dialysis
PubMed: 11229606
DOI: No ID Found -
Peritoneal Dialysis International :... Jun 2008In Japan, two types of new peritoneal dialysis fluid (PDF) are ordinarily used: two-chambered PDF, and icodextrin PDF. Two-chambered PDF has several biocompatible...
In Japan, two types of new peritoneal dialysis fluid (PDF) are ordinarily used: two-chambered PDF, and icodextrin PDF. Two-chambered PDF has several biocompatible characteristics, one being low glucose degradation products (GDPs). Of the several GDPs in PDF, 3,4-dideoxyglucosone-3-ene (3,4-DGE) is thought to be strongly associated with the cytotoxicity of standard PDF. Using a PDF low in GDPs may reduce exposure of the peritoneum to 3,4-DGE, helping to preserve peritoneal function in PD patients. Additionally, use of a PDF low in GDPs may reduce plasma levels of advanced glycosylation end-products in PD patients, a change that may help to preserve vascular function in PD patients. Peritoneal rest for 24 hours after exposure to a PDF with low GDPs improves the activity of human peritoneal mesothelial cells. As compared with the use of standard PDF, the use of low-GDP PDF in combination therapy (peritoneal dialysis plus hemodialysis) may more effectively preserve peritoneal function. The new PDF low in GDPs has biocompatible characteristics relative to peritoneum and system that may help to preserve peritoneal function or reduce complications such as atherosclerosis or dialysis-related amyloidosis in dialysis patients.
Topics: Combined Modality Therapy; Dialysis Solutions; Glucose; Hemodiafiltration; Humans; Japan; Peritoneal Dialysis; Peritoneal Diseases; Peritoneum; Pyrones; Treatment Outcome
PubMed: 18552241
DOI: No ID Found -
Artificial Organs Jul 2009The purposes of this study were to test the human promyelocytic cell line HL60 for its usability as a new cell model for the immune barrier of the peritoneum, and to...
The purposes of this study were to test the human promyelocytic cell line HL60 for its usability as a new cell model for the immune barrier of the peritoneum, and to investigate the impact of different peritoneal dialysis (PD) solutions in the model. HL60 cells were stimulated by retinoic acid and recombinant human granulocyte and macrophage colony-stimulating factor to differentiate into neutrophilic granulocytes. Cells were incubated in different commercially available PD solutions. After a 4-h incubation, functional (chemiluminescence phagocytosis) and viability tests (Live-Dead, XTT) were performed. High glucose concentrations (>1.36%) and low pH values (<7.0) appeared to be detrimental for neutrophil functions and for neutrophil viability. There is a quantitative correlation between glucose concentration and the cytotoxicity of standard PD solutions (PD 1.36% glucose shows 42.6% higher chemiluminescence than PD 3.86% glucose [P < 0.05]). PD solution containing icodextrin shows 74.3% higher chemiluminescence than PD 3.86% glucose, and PD solution with amino acids shows 52.4% higher chemiluminescence than PD 3.86% glucose which is a sign for better biocompatibility in these tests (P < 0.05). The test system is useful for biocompatibility investigations of PD solutions and their effect on immune cells, for example, neutrophil granulocytes. It does not depend on donor variability and availability in comparison to models based on primary isolated leukocytes.
Topics: Cell Differentiation; Cell Survival; Dialysis Solutions; HL-60 Cells; Humans; Neutrophils; Peritoneal Dialysis; Phagocytosis; Tetrazolium Salts
PubMed: 19566731
DOI: 10.1111/j.1525-1594.2009.00735.x -
BMC Nephrology Oct 2017Peritoneal dialysis (PD) is used as renal replacement therapy in patients with end-stage kidney disease. However, peritoneal membrane failure remains problematic and...
BACKGROUND
Peritoneal dialysis (PD) is used as renal replacement therapy in patients with end-stage kidney disease. However, peritoneal membrane failure remains problematic and constitutes a critical cause of PD discontinuation. Recent studies have revealed the unique biological action of molecular hydrogen (H) as an anti-oxidant, which ameliorates tissue injury. In the present study, we aimed to examine the effects of H on the peritoneal membrane of experimental PD rats.
METHOD
Eight-week-old male Sprague-Dawley rats were divided into the following groups (n = 8-11 each) receiving different test solutions: control group (no treatment), PD group (commercially available lactate-based neutral 2.5% glucose PD solution), and HPD group (PD solution with dissolved H at 400 ppb). Furthermore, the influence of iron (FeCl: 5 μM: inducer of oxidative cellular injury) in the respective PD solutions was also examined (Fe-PD and Fe-HPD groups). The HPD solution was manufactured by bathing a PD bag in H-oversaturated water created by electrolysis of the water. Twenty mL of the test solutions were intraperitoneally injected once a day for 10 days. Parietal peritoneum samples and cells collected from the peritoneal surface following treatment with trypsin were subjected to analysis.
RESULTS
In the PD group as compared to controls, a mild but significant sub-mesothelial thickening was observed, with increase in the number of cells in the peritoneal surface tissue that were positive for apoptosis, proliferation and vimentin, as seen by immunostaining. There were significantly fewer of such changes in the HPD group, in which there was a dominant presence of M2 (CD163+) macrophages in the peritoneum. The Fe-PD group showed a significant loss of mesothelial cells with sub-mesothelial thickening, these changes being ameliorated in the Fe-HPD group.
CONCLUSION
H-dissolved PD solutions could preserve mesothelial cells and peritoneal membrane integrity in PD rats. Clinical application of H in PD could be a novel strategy for protection of peritoneal tissue during PD treatment.
Topics: Animals; Dialysis Solutions; Epithelium; Hydrogen; Male; Peritoneal Dialysis; Peritoneum; Rats; Rats, Sprague-Dawley; Solubility
PubMed: 29089029
DOI: 10.1186/s12882-017-0741-0 -
Kidney International Apr 1997For better simulation of the long-dwell exchanges in conventional CAPD, we have developed a modified mesothelial cell culture system consisting of a Transwell culture...
For better simulation of the long-dwell exchanges in conventional CAPD, we have developed a modified mesothelial cell culture system consisting of a Transwell culture apparatus. The equilibration patterns of pH, dextrose and osmolality in the present culture system were observed to be very similar to those in human CAPD. The effects of six different peritoneal dialysis solutions on the apoptosis of mesothelial cells were evaluated using this modified culture system. The results imply that peritoneal dialysis solution per se may incite apoptosis of mesothelial cells, and also that low calcium peritoneal dialysis solution is a milder apoptosis stimulant as compared to the conventional peritoneal dialysis solution. Moreover, varying concentrations of dextrose in the peritoneal dialysis solution were not observed to significantly affect the apoptosis rate. The roles of ambient high concentrations of calcium and dextrose, low pH, as well as high osmolality in the apoptosis are also discussed.
Topics: Apoptosis; Dialysis Solutions; Epithelial Cells; Epithelium; Humans; Hydrogen-Ion Concentration; Microscopy, Electron, Scanning; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum
PubMed: 9083298
DOI: 10.1038/ki.1997.175