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Objective To develop a duplex peritoneal dialyzer with controllable dialysate volume.Methods The dialyzer was designed with considerations on safety and convenience,which was composed of a dialysate feeding bag,a drainage bag,a dialysate changing opening,a dialysate taking opening,a dialysate outlet,a delivery flask,a flow control valve and a compensating bar.There were scales calibrated on the dialysate feeding bag and drainage bag to facilitate flux controlling.The openings of the dialysate feeding bag and drainage bag were connected with the dialysate changing opening by adapting pipe,and the dialysate changing opening could fulfill dialysate input and used dialysate drainage.Results The dialyzer realized dialysis based on actual requirements of the patient,decreased the times for connection to prevent infection due to frequent changing,and lowered the incidence rates of corresponding complications such as peritonitis.Conclusion The disposable dialyzer has easy operation,convenience and high safety,and thus is worthy promoting practically.
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Objective To develop a duplex peritoneal dialyzer with controllable dialysate volume.Methods The dialyzer was designed with considerations on safety and convenience,which was composed of a dialysate feeding bag,a drainage bag,a dialysate changing opening,a dialysate taking opening,a dialysate outlet,a delivery flask,a flow control valve and a compensating bar.There were scales calibrated on the dialysate feeding bag and drainage bag to facilitate flux controlling.The openings of the dialysate feeding bag and drainage bag were connected with the dialysate changing opening by adapting pipe,and the dialysate changing opening could fulfill dialysate input and used dialysate drainage.Results The dialyzer realized dialysis based on actual requirements of the patient,decreased the times for connection to prevent infection due to frequent changing,and lowered the incidence rates of corresponding complications such as peritonitis.Conclusion The disposable dialyzer has easy operation,convenience and high safety,and thus is worthy promoting practically.
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Conventional hemodialysis, which is based on the diffusive transport of solutes, is the most widely used renal replacement therapy. It effectively removes small solutes such as urea and corrects fluid, electrolyte and acid-base imbalance. However, solute diffusion coefficients decreased rapidly as molecular size increased. Because of this, middle and large molecules are not removed effectively and clinical problem such as dialysis amyloidosis might occur. Online hemodiafiltration which is combined by diffusive and convective therapies can overcome such problems by removing effectively middle and large solutes. Online hemodiafiltration is safe, very effective, economically affordable, improving session tolerance and may improve the mortality superior to high flux hemodialysis. However, there might be some potential limitations for setting up online hemodiafiltaration. In this article, we review the uremic toxins associated with dialysis, definition of hemodiafiltration, indication and prescription of hemodiafiltration and the limitations of setting up hemodiafiltration.
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Acid-Base Imbalance , Amyloidosis , Dialysis , Diffusion , Hemodiafiltration , Mortality , Prescriptions , Renal Dialysis , Renal Replacement Therapy , Urea , WaterABSTRACT
Objective To elucidate the biocompatibility differences of 4 dialyzers with different membranes in maintenance hemodialysis (MHD)patients. Methods A total of 60 MHD patients were enrolled in the prospective,randomized,control,cohort study.In baseline,synthetic polysulfone(PS)membrane dialyzer was used in all the patients for at least 3 months.Then the patients were randomly divided into three groups:ployethersulfone(PES)membrane group,cellulose triacetate (CTA)membrane group,and synthetic polymethylmethacrylate(PMMA)membrane group.Study duration was 6 months.No dialyzer was reused.The biocompatibility markers were detected repeatedly at different time points and compared with each other in different dialyzer groups. Results The blood levels of high sensitive C reactive protein,interleukin-1β and interleukin-13 were not significantly different among different groups on every time point.However,the blood complements levels and WBC count were significantly different among four kinds of dialyzer.When the dialyzers changed from PS to PMMA membrane,C3a levels and WBC count changed significantly(P＜0.05).Moreover,the change of C5a level was significantly different between PES group and PMMA group on month 3(P＜0.05). Conclusion There are some differences of biocompatibiliy among different dialyzer membranes.
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Objective To evaluate the efficacy and safety of PES14LF polyethersulfone highflux dialyzer on maintenance hemodialysis(MHD)patients. Methods A total of 72 MHD patients from two hospitals in Shanghai were enrolled in a randomized parallel controlled study.Conventional hemodialysis was performed for 4 h with PES14LF dialyzer in trial group and with German F6 dialyzer in control group.For each patient the study lasted one week.The clearances of urea,creatinine and phosphate were calculated.Adverse event and adverse reaction were recorded.Results There were no significant difierences of urea and creatinine clearance and reduction ratio between trial and control group.The phosphate clearance in trial group was significantly higher than that in control group[(144.57±27.83)ml/min vs(117.15±22.77)ml/min,P＜0.051.There was no significant difference of phosphate reduction ratio between trial and control group.The efficiency of urea clearance and urea reduction ratio achieved clinic effective target in two groups and no significant differences in above indexes between two groups were found. Conclusion PES14LF dialyzer is effective and safe for clinical application.
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Objective To investigate the efficacy and safety of polyethersulfone highlux dialyzer for maintenance hemodialysis patients. Methods Thirty-six maintenance hemodialysis patients were randomizedresigned into two groups,polyethersulfone 14HF(PES-14HF)group and polyethersulfone 150DS(PES-150DS)group,based on a random number table. The patients from two groups received different dialyzer hemodialysis for over 3.5 hours/each time respectively. Changes of serum creatinine,urea,β2-microglobulin,hemoglobin and albumin levels were measured for determination of the efficacy and safety evaluation. Results In the comparison between before or after hemodialysis,the level of serum creatinine,urea,β2-microglobulin levels decreased significantly to(333.8 ± 89. 5)μmol/L,(7. 0 ± 1.9)mmol/L,(22. 9 ± 1.7)mmol/L from(990. 2 ± 191.2)μmol/L,(24. 7 ± 4. 1)mmol/L,(13.6 ± 3.3)mmol/L respectively in the PES1 4 HF group(P ＜ 0.01);the level of serum creatinine,urea,β2-microglobulin levels decreased significantly to(395.5 ± 86.1)μmol/L,(8. 1± 2. 8)mnol/L,(18.0 ± 3.0)mmol/L from(1059. 5 ± 179. 4)μmol/L,(25.3 ± 4. 8)mmol/L,(22. 3 ± 2. 9)mmol/L respectively in the PES-150DS group(P ＜ 0. 01). We found no significant differences in each measured index between two types of hemodialysis(P ＞ 0. 05 respectively),while the level of β2 -microglobulin levels decreased more significantly in the PES14HF group(42. 81 ± 12. 48)mg/L than PES-150DS group(24. 21 ± 13. 24)mg/L(P =0. 017). Conclusions The efficacy and safety of the PES-14HF hollow fiber membrane hemodialyzer is equivalent to that of the PES-150DS hemodialyzer in hemodialysis for uremic patients.
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Objective To evaluate the solute clearance characteristics of REXEEDTM series dialyzers during high-flux dialysis, and explore the care characteristics. Methods A randomized crossover study of 3×3 Latin square was designed based on different dialyzers. Eighteen patients with regular hemodialysis underwent dialysis with REXEEDTM-15AC dialyzer, REXEEDTM-15UC dialyzer and controlled APS-15U dialyzer, respectively. Blood samples were obtained from the blood flow entrance and exit of dialyzers, levels of urea nitrogen, creatinine, phosphate and β2-microglobulin were detected, and solute clearance rates were calculated. Before and after the third dialysis with each dialyzer, blood samples were obtained to measure the levels of urea nitrogen and creatinine, and the rates of decrease were calculated. The vital signs of each patient were intensively observed, and the venous pressure and transmembrane pressure were monitored from the dialyzers. Results The urea nitrogen clearance rates of REXEEDTM-15AC dialyzer and REXEEDTM-15UC dialyzer were significantly higher than that of APS-15U dialyzer (P<0.05). The creatinine clearance rate of REXEEDTM-15AC dialyzer was significantly higher than that of APS-15U dialyzer(P<0.05). There was no significant difference in the rate of decrease in blood urea nitrogen among different dialyzers of the same patient(>65 % for all patients). The vital signs were stable with no adverse events during dialysis, and there was no abnormal findings in laboratory security parameters. Conclusion REXEEDTM series dialyzers are effective and safe for clinical application. Great importance should be attached to the complaints from patients during dialysis. For those with less ultrafiltration, fluid as well as uhrafiltration should be supplemented to increase the transmembrane pressure.
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Objective To evaluate the efficacy and safety of REXEEDTM series highflux dialyzer. Methods A randomized cross-over study of 3×3 Latin square was designed based on the surface area of dialyzer membrane (1.5 m2 and 2.1 m2). Seventy-two stable maintenance hemodialysis (MHD) patients from Shanghai Renji Hospital and Ruijin Hospital were enrolled in this study for 3 consecutive weeks. REXEEDTM-15AC, 15UC, 21AC, 21UC dialyzers were used as trial group and APS-15U,BIO-HX100 dialyzers were used as control group. The clearances of urea, creatinine, phosphorus and β2-microglobulin were calculated. Adverse event and adverse reactions were recorded. Results There were significantly higher urea and creatinine clearance in 1SAC and 15UC dialyzers as compared to APS-15U dialyzer [(222.07±18.74) mi/min, (220.23±26.26) ml/min vs (199.56±14.21) ml/min; (176.73±16.41) ml/min, (175.22±25.94) ml/min vs (165.42±14.68) ml/min, all P<0.05]. There were significantly higher urea, creatinine and β2-microglobulin clearance in 21AC and 21UC dialyzer as compared to BIO-HX100 dialyzer [(230.59±15.24) ml/min, (233.96±7.06) ml/min vs (203.43±36.66) ml/min; (183.50±25.90) ml/min, (181.05±23.94) ml/min vs (166.25±29.82) ml/min; (111.77±53.42) ml/min, (125.54±51.99) ml/min vs (42.39±4.81) ml/min; all P<0.05]. There was no significant difference of phosphorus clearance between REXEEDTM series dialyzers and control dialyzers. The efficiency of urea clearance and urea reduction ratio could achieve clinical targets in REXEEDTM series. Conclusion REXEEDTM series highflux dialyzers are effective and safe for clinical application.
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BACKGROUND: The reprocess by citric acid and heat is an alternative to chemical reprocess for reusing dialyzers. However, there are little experience and data on the effect of reprocess by citric acid and heat on the solute clearance. METHODS: In the 34 chronic hemodialysis patients using low flux dialyzers, solute clearance was measured after reprocessing high-flux dialyzers by citric acid and heat. Dialyzers were reprocessed using 1.5% citric acid solution heated to 95degrees C for 20 hours. The clearance and reduction rate of urea, beta2-microglobulin, osteocalcin and myoglobin were measured at single use and during reuses for 5,10,15,20 and 25 times. RESULTS: The clearance and reduction rate of urea, beta2-microglobulin, osteocalcin and myoglobin were significantly greater with high-flux dialyzer compared with low flux dialyzer, which were maintained after dialyzer reuse. beta2-microglobulin clearance was increased at 10th and 20th reuse and beta2-microglobulin reduction rate was increased at 10th, 20th and 25th reuse compared with the single use. Myoglobin clearance and reduction rate were increased after the 5th reuse compared with the single use. Albumin loss to dialysate was gradually increased following reuses. Of the 34 dialyzers studied, 14 were discarded before the 25th reuse because of inadequate performance test. CONCLUSION: Reprocessing high flux dialyzers by citric acid and heat increases middle and large molecule clearance and was safe.
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BACKGROUND: The reprocess by citric acid and heat is an alternative to chemical reprocess for reusing dialyzers. However, there are little experience and data on the effect of reprocess by citric acid and heat on the solute clearance. METHODS: In the 34 chronic hemodialysis patients using low flux dialyzers, solute clearance was measured after reprocessing high-flux dialyzers by citric acid and heat. Dialyzers were reprocessed using 1.5% citric acid solution heated to 95degrees C for 20 hours. The clearance and reduction rate of urea, beta2-microglobulin, osteocalcin and myoglobin were measured at single use and during reuses for 5,10,15,20 and 25 times. RESULTS: The clearance and reduction rate of urea, beta2-microglobulin, osteocalcin and myoglobin were significantly greater with high-flux dialyzer compared with low flux dialyzer, which were maintained after dialyzer reuse. beta2-microglobulin clearance was increased at 10th and 20th reuse and beta2-microglobulin reduction rate was increased at 10th, 20th and 25th reuse compared with the single use. Myoglobin clearance and reduction rate were increased after the 5th reuse compared with the single use. Albumin loss to dialysate was gradually increased following reuses. Of the 34 dialyzers studied, 14 were discarded before the 25th reuse because of inadequate performance test. CONCLUSION: Reprocessing high flux dialyzers by citric acid and heat increases middle and large molecule clearance and was safe.
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The major clinical advantages of dialyzer reuse are improved biocompatibility and a decrease in the frequency of the first use syndrome. Dialyzer reuse has made it possible to use biocompatible high flux membranes of the high price. Although dialyzer reuse in chronic hemodialysis patients is commonly practiced in the United States, it is not widely accepted in Korea. At Ajou University Hospital, we have reprocessed dialyzers since March 2000, and here we report our clinical experience for the 1st 8 weeks. We used high flux dialyzers with reprocessing practice in 24 chronic hemodialysis patients. Dialyzer reprocessing was performed by an automated machine(Renatron) using Renalin. We limited reuse upto 20 times, and we were able to reuse dialyzers upto this number in 17 patients. During the study period, no significant complication was observed as a result of the reuse program. Kt/Vurea and urea reduction ratio(URR) were not different between high and low flux dialyzers(1.41+/-0.29 vs 1.61+/-0.41 for Kt/Vurea and 66.70+/- 6.40% vs 65.69+/-5.63% for URR). In contrast, beta2-microglobulin(beta2M) reduction ratio and clearance were greater in high flux dialyzers than low flux dialyzers(p<0.001, -9.52+/-20.28% vs 42.00+/-8.61% for beta2M reduction ratio and 9.54+/-11.71mL/min vs 48.54+/-14.33mL/min for beta2M clearance). Kt/Vurea, URR, beta2M reduction ratio and beta2M clearance did not deteriorate with the increasing number of reuse. The predialysis values of beta2M decreased by 51% after 19 uses(p<0.001, 37.04+/-13.39 to 18.98+/-3.41mg/L). In summary, during the short pilot study period of 8 weeks, no significant clinical complication was encountered as a result of dialyzer reuse, and our results confirmed the effects of high flux dialyzers on removal of beta2M.
Subject(s)
Humans , Kidneys, Artificial , Korea , Membranes , Pilot Projects , Renal Dialysis , United States , UreaABSTRACT
The major clinical advantages of dialyzer reuse are improved biocompatibility and a decrease in the frequency of the first use syndrome. Dialyzer reuse has made it possible to use biocompatible high flux membranes of the high price. Although dialyzer reuse in chronic hemodialysis patients is commonly practiced in the United States, it is not widely accepted in Korea. At Ajou University Hospital, we have reprocessed dialyzers since March 2000, and here we report our clinical experience for the 1st 8 weeks. We used high flux dialyzers with reprocessing practice in 24 chronic hemodialysis patients. Dialyzer reprocessing was performed by an automated machine(Renatron) using Renalin. We limited reuse upto 20 times, and we were able to reuse dialyzers upto this number in 17 patients. During the study period, no significant complication was observed as a result of the reuse program. Kt/Vurea and urea reduction ratio(URR) were not different between high and low flux dialyzers(1.41+/-0.29 vs 1.61+/-0.41 for Kt/Vurea and 66.70+/- 6.40% vs 65.69+/-5.63% for URR). In contrast, beta2-microglobulin(beta2M) reduction ratio and clearance were greater in high flux dialyzers than low flux dialyzers(p<0.001, -9.52+/-20.28% vs 42.00+/-8.61% for beta2M reduction ratio and 9.54+/-11.71mL/min vs 48.54+/-14.33mL/min for beta2M clearance). Kt/Vurea, URR, beta2M reduction ratio and beta2M clearance did not deteriorate with the increasing number of reuse. The predialysis values of beta2M decreased by 51% after 19 uses(p<0.001, 37.04+/-13.39 to 18.98+/-3.41mg/L). In summary, during the short pilot study period of 8 weeks, no significant clinical complication was encountered as a result of dialyzer reuse, and our results confirmed the effects of high flux dialyzers on removal of beta2M.
Subject(s)
Humans , Kidneys, Artificial , Korea , Membranes , Pilot Projects , Renal Dialysis , United States , UreaABSTRACT
It has been known that access recirculation is positively related to dialyzer blood flow and is negatively related to access blood flow in the vascular access in hemodialysis patients. The present study was designed to examine whether an increase in access recirculation generated by an increase in dialyzer blood flow is related to access blood flow. All patients had native end-to-side arteriovenous anastomoses at the radial site. We measured access recirculation at two different dialyzer blood flow rates (85 and 170 ml/min) using a three-needle technique. Access blood flow rates (mean 668 ml/min ranging from 493 to 1038 ml/min) were measured using Doppler ultrasound sonography. We confirmed that an increase in dialyzer blood flow rate led to an increase in access recirculation (5.4±1.1 vs. 9.9±1.9%, p<0.05), and that access recirculation was negatively related to the access blood flow rate (y=-30.78x+972.20, r=-0.79, p<0.05). We further found a negative correlation between the increase in access recirculation generated by the increase in dialyzer blood flow rate and access blood flow rate (y=-33.88x+821.57, r=-0.75, p<0.05). These results suggested that dialyzer blood flow less affects access recirculation when access blood flow is higher.
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The use of erythropoietin for correction of anemia in maintenance hemodialysis patients affects dialyzer reuse, dialysis efficacy and other clinical parameters. This study showed the change of Kt/Vurea, nPCR, pre-dialysis BUN, body weight, ultrafiltration volume, pre-dialysis blood pressure, heparin dosage, the number of dialyzer reuse caused by the administration of erythropoietin in reuse(n=11) and first use(n=9) patients who were started erythropoietin since January, 1995. 1) In 20 all patients, hematocrit increased significantly after EPO treatment 20.7+/-0.8%, 27.8+/-0.7%, ultrafiltration volume increased from 2.0+/-0.3L to 2.5+/-0.2L(P1.0/kg/ day) and then pretreatment versus posttreatment nPCR, pre-dialysis BUN and ultrafiltration volume were compared. In low baseline protein intake group, significant increases of ultrafiltration volume, nPCR were observed. However, pre-dialysis BUN were not changed significantly. In high protein intake group, nPCR, pre-dialysis BUN, ultrafiltration volume were changed without significance. In conclusion, EPO treatment did not affect Kt/Vurea, dialyzer reuse, nPCR, predialysis blood pressure, heparin dosage. But ultrafiltration volume increased significantly after EPO treatment. Maybe increased appetite in low baseline protein intake group caused the increased posttreatment ultrafiltration volume.
Subject(s)
Humans , Anemia , Appetite , Blood Pressure , Body Weight , Dialysis , Erythropoietin , Hematocrit , Heparin , Renal Dialysis , UltrafiltrationABSTRACT
RT-PCR and in situ hybridization were observed during dialyzer reuse. Results Every plasma cytokine level was decreased during reuse compared with first use dialyzer, but no significant difference was found between them. The levels of gene expression of IL-1?、TNF-? and IL-6 were different from the first use significantly. Conclusion If effective dialysis volumn was maintained, formaldehyde as disinfectant on reprocessing the dialyzer may amilorate membrane bio-compatibility. It would be benificial to decrease appearance of long term hemodialysis -related complications.
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There existed conflictsin dialyzer reusing among medicine, economics and law in China. The author analyzed the causes and the problems of dialyzer reusing. In China, reusing dialyzer was determined by economical reason. The conclusions were draw that the dialyzer reusing would lessen the pressure of both patients and society, but it would increase the medical risks. Reusing dialyzer consisted with the principle of medical ethics.