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Journal of Artificial Organs : the... Jun 2024Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin... (Review)
Review
Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin losses considers albumin "leaking" into the dialysate and losses due to protein/membrane interactions (i.e. adsorption, "secondary membrane formation" and denaturation). The former are fairly easy to determine, usually varying at the level of ~ 2 g to ~ 7 g albumin loss per session. Such values, commonly accepted as representative of the total albumin losses, are often quoted as limits/standards of permissible albumin loss per session. On albumin mass lost due to adsorption/deposition, which is the result of complicated interactions and rather difficult to determine, scant in vivo data exist and there is great uncertainty and confusion regarding their magnitude; this is possibly responsible for neglecting their contribution to the total losses at present. Yet, many relevant in vitro studies suggest that losses of albumin due to protein/membrane interactions are likely comparable to (or even greater than) those due to leaking, particularly in the currently favoured high-convection HDF (haemodiafiltration) treatment. Therefore, it is emphasised that top research priority should be given to resolve these issues, primarily by developing appropriate/facile in vivo test-methods and related analytical techniques.
Topics: Humans; Hypoalbuminemia; Renal Dialysis; Serum Albumin; Dialysis Solutions; Hemodiafiltration
PubMed: 38238597
DOI: 10.1007/s10047-023-01430-y -
Seminars in Dialysis Nov 2018In the 1980s, conventional hemodialysis was considered as dialysis with acetate dialysate, dialysis machines without volumetric control, low blood flow and low-flux... (Review)
Review
In the 1980s, conventional hemodialysis was considered as dialysis with acetate dialysate, dialysis machines without volumetric control, low blood flow and low-flux dialyzers; in the 1990s, the concept of conventional hemodialysis changed due to technological advances in dialysis machines, control of ultrafiltration and the widespread use of bicarbonate dialysate, which allowed an increase in blood flow and the use of synthetic high-flux dialyzers. To avoid backfiltration-induced adverse reactions, exogenous replacement fluid was promoted but its adoption was limited for technical and financial reasons. This scenario changed in 1995 with the development of on-line hemodiafiltration (HDF) techniques using the dialysis fluid itself as a replacement fluid. Dialysis machines were modified to perform on-line HDF, incorporating safety filters to ensure the quality of this replacement fluid (ultrapure dialysate). After more than two decades of clinical experience and technological development with high-volume HDF, the present article discusses whether HDF can currently be considered as the standard conventional treatment for chronic hemodialysis patients. A review of the evidence indicates that the time has come to consider HDF as the conventional hemodialysis treatment for the following reasons: first, technological development in water treatment and advances in dialysis machines, as well as the widespread use of synthetic high-flux dialyzers has made it a feasible proposition. Second, there is an absence of published literature showing any undesirable effects. Finally, scientific evidence is available showing the superiority of HDF over hemodialysis in overall and cardiovascular mortality in both prevalent and incident patients.
Topics: Dialysis Solutions; Humans; Kidney Failure, Chronic; Renal Dialysis; Survival Rate
PubMed: 29813181
DOI: 10.1111/sdi.12715 -
Blood Purification 2004Preserving residual renal function (RRF) after initiation of dialysis therapy is desirable for improving quality of life in ESRD patients. It has been believed that RRF... (Review)
Review
Preserving residual renal function (RRF) after initiation of dialysis therapy is desirable for improving quality of life in ESRD patients. It has been believed that RRF declines more slowly in patients receiving continuous ambulatory peritoneal dialysis (CAPD) than in patients treated with other forms of maintenance dialysis. Episodes of intravascular volume depletion might be expected to cause more rapid loss of RRF, and are more frequent in patients on hemodialysis, which is intermittent therapy. However, recently it was demonstrated that in hemodialysis using high-flux biocompatible membrane and ultrapure water, RRF declines at a rate indistinguishable from that in CAPD. The HDF using ultrapure dialysate and the substitution fluid may show to preserve RRF as well as CAPD patients. In future, it might be a major concern for the assessment of the HDF by a multicenter clinical study for preserving RRF.
Topics: Dialysis Solutions; Humans; Kidney Failure, Chronic; Membranes, Artificial; Peritoneal Dialysis; Renal Dialysis; Survival Rate; Treatment Outcome
PubMed: 15655327
DOI: 10.1159/000081878 -
Seminars in Dialysis 2009The confluence of an increasing prevalence of end-stage renal disease (ESRD), clinical trial data suggestive of benefit from quotidian dialysis, and ongoing cost/benefit... (Review)
Review
The confluence of an increasing prevalence of end-stage renal disease (ESRD), clinical trial data suggestive of benefit from quotidian dialysis, and ongoing cost/benefit reanalysis of healthcare spending have stimulated interest in technological improvements in provision of ESRD care. For the last decade, our group has focused on enabling technologies that would permit a paradigm shift in dialysis care similar to that brought by implantable defibrillators to arrhythmia management. Two significant barriers to wearable or implantable dialysis persist: package size of the dialyzer and water requirements for preparation of dialysate. Decades of independent research into highly efficient membranes and cell-based bioreactors culminated in a team effort to develop an implantable version of the University of Michigan Renal Assist Device. In this review, the rationale for the design of the implantable artificial kidney is described.
Topics: Bioreactors; Dialysis Solutions; Hemodiafiltration; Humans; Kidney Failure, Chronic; Kidneys, Artificial; Membranes, Artificial; Permeability; Renal Replacement Therapy
PubMed: 20017839
DOI: 10.1111/j.1525-139X.2009.00662.x -
Nihon Jinzo Gakkai Shi Feb 2004Combined peritoneal dialysis and hemodialysis therapy (combined therapy) is recognized as an effective alternate in peritoneal dialysis patients with insufficient water...
Combined peritoneal dialysis and hemodialysis therapy (combined therapy) is recognized as an effective alternate in peritoneal dialysis patients with insufficient water and solute removal, but there is no appropriate index for dialysis dose, as two distinct dialysis procedures are utilized in the same patient. Among several candidate parameters, the dilution index proposed and defined by Yamada, et al as the solute generation rate divided by the distribution volume and time-averaged concentration of the solute might be applicable, because it is unrelated to the method of solute removal. Among 11 patients undergoing combined therapy at Toride Kyodo General Hospital, six patients who had transferred from peritoneal dialysis alone to combined therapy were recruited. All patients received peritoneal dialysis therapy for five consecutive days followed by one day off dialysis before a hemodialysis session on the seventh day every week. Total weekly creatinine and urea removal by residual renal function, peritoneal dialysis, and hemodialysis were measured, and their solute removal on the last(5th) day under peritoneal dialysis was ascertained and correlated with the averaged daily removal of solutes. Hence the value of solute removal obtained on the last day under peritoneal dialysis was multiplied seven times and defined as the weekly solute generation. The distribution volumes of creatinine and urea were defined as 58% of body weight. The time-averaged concentration was obtained from the mean level of a solute before and after a hemodialysis session. During the period followed solely by peritoneal dialysis, the dilution indices for creatinine and urea were 1.22 +/- 0.14 and 1.85 +/- 0.14, respectively. The dilution index after transferring to combined therapy, calculated by the above-mentioned method was increased to 1.72 +/- 0.29 and 2.28 +/- 0.31, respectively. Hence the dilution index may be useful for reflecting dialysis doses even in combined therapy.
Topics: Combined Modality Therapy; Creatinine; Dialysis Solutions; Humans; Indicator Dilution Techniques; Peritoneal Dialysis; Renal Dialysis; Urea
PubMed: 15058106
DOI: No ID Found -
Disease Markers 2018Indoxyl sulfate has been identified as a major factor in the dysregulation of several genes. It is classified as a poorly dialyzable uremic toxin and thus a leading... (Clinical Trial)
Clinical Trial
Indoxyl sulfate has been identified as a major factor in the dysregulation of several genes. It is classified as a poorly dialyzable uremic toxin and thus a leading cause in the poor survival rate of dialysis patients. A monocentric, prospective, open cohort study was performed in 43 male patients undergoing chronic renal replacement therapy in a single hemodialysis center. The aim of the study was to determine the influence of acetate- versus citrate-buffered dialysis fluids in hemodialysis (HD) and postdilution hemodiafiltration (HDF) settings on the elimination of indoxyl sulfate. Also, additional factors potentially influencing the serum concentration of indoxyl sulfate were evaluated. For this purpose, the predialysis and postdialysis concentration ratio of indoxyl sulfate and total protein was determined. The difference was of 1.15 (0.61; 2.10), 0.89 (0.53; 1.66), 0.32 (0.07; 0.63), and 0.44 (0.27; 0.77) mol/g in acetate HD and HDF and citrate HD and HDF, respectively. Acetate HD and HDF were superior when concerning IS elimination when compared to citrate HD and HDF. Moreover, residual diuresis was determined as the only predictor of lower indoxyl sulfate concentration, suggesting that it should be preserved as long as possible. This trial is registered with EU PAS Register of Studies .
Topics: Acetates; Aged; Bicarbonates; Citric Acid; Dialysis Solutions; Hemodiafiltration; Humans; Indican; Kidney Diseases; Male; Middle Aged; Prospective Studies; Renal Dialysis
PubMed: 30186534
DOI: 10.1155/2018/3985861 -
Seminars in Dialysis 2006Renal replacement therapy (RRT) is increasingly used in intensive care as acute renal failure (ARF) is a common and constantly increasing complication in this setting.... (Review)
Review
Renal replacement therapy (RRT) is increasingly used in intensive care as acute renal failure (ARF) is a common and constantly increasing complication in this setting. Different forms of RRT such as intermittent hemodialysis, continuous hemofiltration, or hybrid forms, which combine advantages of both, are available and will be discussed in this article. As a general survival benefit for neither method has been demonstrated, it is the task of the nephrologist or intensivist to choose the RRT strategy that is most advantageous for each individual patient. The choice of RRT might depend not only on the underlying disease, the time course of the disease, the etiology of ARF, the actual clinical status of the patient but also on the resources available and the cost of therapy. An adequate dose of RRT seems to result in improved survival in patients with ARF. However, clear guidelines on the dose of RRT and the timing of initiation are still lacking. Moreover, it will be discussed whether patients with sepsis and septic shock benefit from early RRT initiation, the use of increased RRT doses, and increased removal of inflammatory mediators by RRT.
Topics: Acute Kidney Injury; Critical Illness; Dialysis Solutions; Dose-Response Relationship, Drug; Hemofiltration; Humans; Intensive Care Units; Multiple Organ Failure; Renal Dialysis; Time Factors
PubMed: 17150045
DOI: 10.1111/j.1525-139X.2006.00207.x -
Journal of Nephrology Feb 2021
Topics: Calcium; Cinacalcet; Dialysis Solutions; Humans; Hypocalcemia; Renal Dialysis
PubMed: 32342328
DOI: 10.1007/s40620-020-00741-0 -
Clinical Journal of the American... Jan 2012
Topics: Dialysis Solutions; Female; Humans; Male; Renal Dialysis; Sodium; Weight Gain
PubMed: 22173861
DOI: 10.2215/CJN.12101111 -
Artificial Organs May 2022By the year 2000, there was rising interest in home hemodialysis in the United States. HemoCleanse decided to resurrect the BioLogic-HD machine, using updated...
By the year 2000, there was rising interest in home hemodialysis in the United States. HemoCleanse decided to resurrect the BioLogic-HD machine, using updated components. A spin-off company Renal Solutions (RSI) created the Allient™, with sorbent regeneration of dialysate, hollow fiber dialyzer, pressure-controlled blood flow rate, controlled filtration, and single- or dual-needle access. RSI merged with Sorb Technology and the Allient™ was built, tested, and FDA-approved to market. In 2007 Fresenius Medical Corporation (FMC) bought RSI. FMC began an extensive re-design of the machine to fit the needs of both in-center and home dialysis. The redesigned machine never was marketed.
Topics: Dialysis Solutions; Needles; Renal Dialysis
PubMed: 35313038
DOI: 10.1111/aor.14230