Effects of Dialyzer Membrane Characteristics on Serum Total Protein and Albumin Concentration in Hemodialysis Patients / 日本農村医学会雑誌

Recent studies showed that high biocompatibility and reduction of uremic toxin contributed to the improvement of freatment outcome in hemodialysis patients.Therefore, a high-flux membrane dialyzer, especially polysulfone (PS) membrane, was generally used in dialysis. However, it was suggested that the higher efficiency of reduction in uremic toxins might cause an increase in the albumin leakage through the dialyzer membrane during dialysis, resulting in a decrease in serum albumin concentration. In this study, we used two different dialyzer membranes with high biocompatibility, namely, ethylenevinylalcohol (EVAL) membrane and improved PS membrane with a very lower leakage of serum albumin. After using these two types of mambrane of six straight months, we examined the effect of each dialyzer membrane characteristic on the serum total protein and albumin concentration. The reduction rates of each uremic solute and serum total protein concentration were significantly higher. The serum albumin concentration and its rate of change with the passing of time tended to increase in the case of the PS membrane. But in the case of EVAL membrane, these values tended to decrease. These results suggested that the differences in the changes in the serum total protein and albumin concentration might result from the differences in the efficiency of the reduction of uremic toxins. Therefore, it is necessary to consider the usage of the dialyzer membrane with a higher reduction of uremic solutes and a lower leakage of serum albumin to add to the higher biocompatibility specially in hemodialysis patients with hypoproteinemia.

Nutritional Status in Hemodialysis Patients - Changes in Biochemical Parameters and Clinical Symptoms / 日本農村医学会雑誌

A strong earthquake (magnitude 6.8) off the Sea of Japan struck the Chuetsu area of Niigata Prefecture on July 16, 2007. By way of investigating the impact of the earthquake on the health of maintenance hemodialysis patients, we examined several biochemical parameters including nutritional markers and psychological stress markers and checked up on the incidence of earthquake-induced complications (heart failure and shunt obstruction). Blood samples were collected and the values of several biochemical parameters were measured. Incidences of clinical complications one, three and six months after the quake were scrutinized. Significant decreases in the nutritional markers and a significant increase in the incidence of complications were found one month after the quake. During this period, the supplies of electricity, city gas and water were completely recovered one after another. The significant changes in the nutritional levels and the incidence of complications coincided with the time of the complete recovery of these utilities. The levels of these parameters recovered and the incidence of complications reduced three months after the quake. However, the serum albumin level did not recover and remained significantly lower even six months after. The psychological stress markers increased significantly three months after. These suggested that there was the time lag between the decrease in the nutritional markers, the increase in the incidence of complications (1 month after earthquake) and the increases in the psychological stress markers (3 months after earthquake). We concluded that these findings provided important information for the total medical plan to maintain the physical and psychological states of hemodialysis patients in an earthquake- stricken district.