Review of Leachable Substances in Hemodialyzer / 中国医疗器械杂志

With the rapid development of my country's hemodialysis industry, the application of hemodialysis machines has become more and more extensive, but at the same time, the quality control technology of hemodialysis machines is not perfect. Especially for a wide range of leachable substances in dialyzers, there are few studies and detection methods. This study first briefly describes the development of hemodialyzers, and then expounds the common types of leachables, extraction methods, and chromatography and mass spectrometry conditions. It is summarized that the research plan of leachable substances is to determine the type first, then formulate the extraction plan, and then establish the detection method. Finally, we look forward to the research prospects of hemodialyzer leachables, and point out that with the deepening and extensive development of research, it can further promote the healthy development of the hemodialyzer industry.

Clinical and microbiological effects of dialyzers reuse in hemodialysis patients / Efeitos clínicos e microbiológicos do reúso de dialisadores em pacientes em hemodiálise

Abstract Introduction: Chronic kidney disease (CKD) has a high prevalence and is a worldwide public health problem. Reuse of dialyzers is a cost reduction strategy used in many countries. There is controversy over its effects on clinical parameters and microbiological safety. Methods: In this clinical crossover study, 10 patients performed consecutive hemodialysis (HD) sessions divided in two phases: "single use" sessions (N = 10 HD sessions) followed by "dialyzer reuse" sessions (N = 30 HD sessions). Clinical, laboratory, and microbiological parameters were collected in the following time points: "single use", 1st, 6th, and 12th sessions with reuse of dialyzers, including bacterial cultures, endotoxins quantification in serum and dialyzer blood chamber, and detection of hemoglobin and protein residues in dialyzers. Results: Mean age of the sample was 37 ± 16 years, 6 (60%) were men, and 5 (50%) were white. CKD and HD vintage were 169 ± 108 and 47 (23-111) months, respectively. Serum C-reactive protein (CRP) [4.9 (2.1) mg/mL], ferritin (454 ± 223 ng/mL), and endotoxin levels [0.76 (0.61-0.91) EU/mL] were high at baseline. Comparison of pre- and post-HD variations of serum levels of CRP and endotoxins in the "single use" versus "reuse" phases did not result in differences (p = 0.8 and 0.4, respectively). Samples of liquid in the dialyzer inner chamber were negative for the growth of bacteria or endotoxins. There was no significant clinical manifestation within and between the phases. Conclusion: Dialyzers reuse was safe from a clinical, microbiological, and inflammatory point of view. The dialyzer performance remained adequate until the 12th reuse.

Resumo Introdução: A doença renal crônica (DRC) é um problema de saúde pública mundial de alta prevalência. O reúso de dialisadores é uma estratégia de redução de custos empregada em muitos países. Seus efeitos sobre parâmetros clínicos e de segurança microbiológica são alvo de controvérsia. Métodos: No presente estudo clínico cruzado, 10 pacientes realizaram sessões consecutivas de hemodiálise (HD) divididas em duas fases: a primeira com sessões de "uso único" (N = 10 sessões de HD) e a segunda com sessões com "reúso de dialisadores" (N = 30 sessões de HD). Parâmetros clínicos, laboratoriais e microbiológicos foram registrados nos seguintes momentos: "uso único", 1a, 6a e 12a sessões com reúso de dialisadores, incluindo culturas bacterianas, quantificação de endotoxinas no soro e na câmara interna do dialisador e detecção de hemoglobina e resíduos de proteína nos dialisadores. Resultados: A idade média da amostra foi de 37 ± 16 anos seis (60%) eram homens e cinco (50%) eram brancos. Os tempos com DRC e em HD foram de 169 ± 108 e 47 (23-111) meses, respectivamente. Os níveis séricos de proteína C-reativa (PCR) [4,9 (2,1) mg/mL], ferritina (454 ± 223 ng/mL) e endotoxinas [0,76 (0,61-0,91) UE/mL] estavam elevados no início do estudo. A diferença dos níveis séricos de PCR e endotoxinas pré e pós-HD nas fases de "uso único" e "reúso" não foi significativa (p = 0,8 e 0,4, respectivamente). As amostras de líquido retiradas da câmara interna do dialisador foram negativas para crescimento de bactérias e endotoxinas. Não houve registro de manifestações clínicas significativas nas fases do estudo. Conclusão: O reúso de dialisadores foi seguro dos pontos de vista clínico, microbiológico e inflamatório. O desempenho do dialisador permaneceu adequado até o 12º reuso.

Bioactive Compounds for the Treatment of Renal Disease

Kidney diseases including acute kidney injury and chronic kidney disease are among the largest health issues worldwide. Dialysis and kidney transplantation can replace a significant portion of renal function, however these treatments still have limitations. To overcome these shortcomings, a variety of innovative efforts have been introduced, including cell-based therapies. During the past decades, advances have been made in the stem cell and developmental biology, and tissue engineering. As part of such efforts, studies on renal cell therapy and artificial kidney developments have been conducted, and multiple therapeutic interventions have shown promise in the pre-clinical and clinical settings. More recently, therapeutic cell-secreting secretomes have emerged as a potential alternative to cell-based approaches. This approach involves the use of renotropic factors, such as growth factors and cytokines, that are produced by cells and these factors have shown effectiveness in facilitating kidney function recovery. This review focuses on the renotropic functions of bioactive compounds that provide protective and regenerative effects for kidney tissue repair, based on the available data in the literature.

Level of Nutrition Knowledge, Diet Practice and Education Demands in Dialysis Patients with Chronic Renal Failure

The number of patients is increasing and their mean age is also increasing. Proper dietary adjustments are necessary to prevent protein-calorie malnutrition or complications but it is difficult for dialysis patients to adapt to diet therapy due to stress or anorexia. Education does not consider the individual characteristics, knowledge, dietary inhabit education demands, and initial education. The purpose of this study was to identify dialysis patient's nutrition knowledge and, dietary practice and compare those with nutrition education or counseling demands for providing basic data of desirable nutrition management. The data were collected by a survey consisting of the general characteristics, disease related characteristics, nutrition education and counsel characteristics, level of nutrition knowledge, diet therapy, and nutrition education and counsel demands from the 28th March to 22th July 2017. The total number of subjects were 33 patients among dialysis patients at two tertiary medical institutions and an artificial kidney room at a private hospital in Incheon·Gyeonggi. The data collected were analyzed statistically using the SPSS program 23.0, followed by further analyses using frequency analysis, one-way ANOVA, cross analysis, and correlation analysis. The results of the dialysis patients showed that younger (P < 0.05), female (P < 0.05), abnormal high school diploma (P < 0.001) groups had high nutrition scores. In addition, dietary practice and nutrition education and counsel demands showed a positive correlation (P < 0.05, P < 0.01). In particular, females were higher than males in nutrition knowledge, dietary practice, nutrition education, and counseling demand scores.

Dialisador capilar reutilizado e de uso único em hemodiálise: implicações na saúde dos profissionais, em desfechos clínicos e custos

A reutilização do dialisador capilar em hemodiálise é uma prática realizada em muitos países, apesar de não haver consenso sobre sua segurança e eficácia em comparação ao dialisador de uso único. Em relação ao uso único, apontam-se os custos como grande entrave e a preocupação com o aumento do lixo hospitalar. No que se refere aos riscos do reuso, aponta-se a exposição dos profissionais aos produtos químicos necessários à realização do processo de reutilização, assim como movimentos repetitivos envolvidos na dinâmica dessa técnica; somadas a isto, a redução da eficiência da membrana, a contaminação do sistema, as infecções cruzadas, as reações pirogênicas e as bacteremias. Nesse sentido, tornam-se relevantes estudos que investiguem o efeito da adoção desses métodos nesses desfechos. Objetivos: Comparar as implicações do dialisador reutilizado (reuso) com as do utilizado uma única vez (uso único) na saúde dos profissionais, nos desfechos clínicos e custos de pacientes em hemodiálise. Métodos: Estudo longitudinal, com coleta de dados retrospectiva, realizado em um Hospital Público Universitário (Janeiro de 2015 a Fevereiro de 2016). Foram incluídos 18 técnicos de enfermagem e 34 pacientes renais crônicos submetidos à hemodiálise nos dois períodos do estudo (período de reuso e período de uso único), por meio de cateter, fístula ou enxerto, com fluxo de sangue de pelo menos 300 ml/min. e tempo de diálise definido entre três a quatro horas por sessão. Considerou-se como desfechos primários os distúrbios osteomusculares, irritação ocular, as dermatoses, afastamento do trabalho e uso de medicações. Como secundários, hemodinâmica, volemia, exames laboratoriais, reações pirogênicas, bacteremias, uso de antibióticos e custos diretos e indiretos do procedimento. Projeto aprovado no Comitê de Ética da instituição...

Capillary dialyzer reuse in hemodialysis is a practice carried out in many countries, although there is no consensus about its safety and effectiveness in comparison with the single-use dialyzer. Regarding the single-use dialyzer, costs are considered a major obstacle, as is the concern with the increase in medical waste. In what concerns the risks of reuse, the exposure of the professionals to chemicals needed to carry out the process of reuse, as well as the repetitive movements involved in the dynamics of this technique stand out; added to this, there are the reduced efficiency of the membrane, the contamination of the system, crossinfections, pyrogenic reactions and bacteremia. In this sense, a study which investigates the effect of the adoption of these methods in these outcomes becomes relevant. Objectives: To compare the implications of reused dialyzer with single-use dialyzer on the health of professionals, clinical outcomes and costs of patients in hemodialysis. Methods: Longitudinal study with retrospective data collection, carried out in a Public University Hospital (January 2015 to February 2016). Participated in the study 18 nursing technicians and 34 chronic kidney patients subjected to hemodialysis in the two periods of the study (reuse and single-use periods), through catheter, fistula or graft, with blood flow of at least 300 mL/min, dialysis time set between three to four hours per session. Musculoskeletal disorders, eye irritation, skin diseases, work leave and the use of medications were considered as primary outcomes. Secondary included hemodynamics, blood volume, laboratory tests, pyrogenic reactions, bacteremia, antibiotic use, direct and indirect costs of the procedure. The project was approved by the Ethics Committee of the institution...

A Better Diet Quality is Attributable to Adequate Energy Intake in Hemodialysis Patients

Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 +/- 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet records were obtained for dietary assessment. Mean adequacy ratio (MAR) is the average of the ratio of intakes to Dietary Reference Intakes (DRI) for 12 nutrients. Index of nutritional quality (INQ) was determined as the nutritional density per 1,000 kcal of calories. Overall diet quality was evaluated using the Diet Quality Index-International (DQI-I). Statistics were used to determine diet quality, comparing dietary intake to DRI. Dietary calories (21.9 +/- 6.7 kcal/kg/day) and protein (0.9 +/- 0.3 g/kg/day) were found insufficient in the participants. The overall intake of 12 nutrients appeared to be also inadequate (0.66 +/- 0.15), but INQs of overall nutrients, except for folate (0.6) and calcium (0.8), were found relatively adequate (INQ > or = 1). As a result of diet quality assessment using DQI-I, dietary imbalance and inadequacy were found to be the most problematic in hemodialysis patients. This study suggests that the main reason for insufficient intake of essential nutrients is insufficient calorie intake. Hemodialysis patients should be encouraged to use various food sources to meet their energy requirements as well as satisfy overall balance and nutrient adequacy.

Association of diet-related quality of life with dietary regimen practice, health-related quality of life, and gastrointestinal symptoms in end-stage renal disease patients with hemodialysis

The purpose of this study was to evaluate diet-related Quality of Life (QOL) and to analyze the relationship among diet-related QOL, dietary regimen practice, health-related QOL, and gastrointestinal symptoms in hemodialysis patients. Subjects were recruited from an artificial kidney center in Seoul. The self-report questionnaire consisted of socio-demographic characteristics, diet-related QOL, compliance with dietary regimen practice, health-related QOL, and gastrointestinal symptoms was distributed. Diet-related QOL includes a 'Quality of Life and Related to Dietary Change Questionnaire', 'Satisfaction Survey', and 'Dietary Impact Survey'. According to their responses, participants had experienced the greatest difficulty with 'Dietary Impact'. In particular, the mean score for general health was low. Association of dietary regimen practice showed a positive association with 'Cost' and 'Self-care' score. In addition, diet-related QOL showed positive correlation with health-related QOL, particularly in 'taste'. Scores for 'Taste', 'Convenience', and 'Dietary Impact' were lower for subjects with constipation compared to those of subjects without constipation. Scores for 'Taste' and 'Dietary Impact' were lower in subjects with irritable bowel syndrome compared to those of subjects without the syndrome (p < 0.05). Diet-related QOL showed a positive association with health-related QOL (p < 0.05), whereas it showed a negative association with constipation (p < 0.01). In conclusion, hemodialysis patients in Korea suffer from burden of dietary regimen practice and most scores for diet-related QOL and health-related QOL from patients with gastrointestinal symptoms were low. Therefore, appropriate nutrition education considering gastrointestinal symptoms is necessary for improvement of patients' QOL during dietary regimen practice.

History and Development of Vascular Access and Its Impact on Hemodialysis Outcome

Maintenance hemodialysis is a mainstay of the renal replacement therapy for patients with end stage renal disease. The development of modern hemodialysis is principally owing to the invention of artificial kidney machine and the establishment of a stable and practical dialysis access. The developmental history of vascular access surgery will be discussed with the heroic works of the pioneers.

Bisphenol A, an Endocrine Disruptive Chemical, is Released from Cellulosynthetic Dialyzer (Hemophan(R)) during Hemodialysis / 대한신장학회잡지

BACKGOUND: Bisphenol-A (2,2-bis (4-hydroxyphenyl)propane, BPA) is suspected to be an endocrine disruptor. BPA is a component of polycarbonate (PC), polysulfone (PS), and epoxy resins. PC is used as a material in the case header. Evaluation of BPA release from hemodialyzers may be very important, because BPA released from hemodialyzers is directly introduced into blood circulation. We examined the plasma levels of BPA before and after a hemodialysis session to evaluate the degree of BPA in patients with regular hemodialysis. METHODS: Ten patients undergoing regular hemodialysis were enrolled. We used cellulosynthetic dialyzer (Hemophan(R)-Alwall GFS Plus 2) and Bisphenol A concentration in plasma that had been taken before and after a hemodialysis session determined by gas chromatography-mass spectrometry (GC/MS) analysis. RESULTS: Plasma BPA levels before and after a hemodialysis session were 0.02+/-0.05 ng/mL and 0.16+/-0.15 ng/mL respectively. Plasma BPA levels after a hemodialysis session were significantly higher than those before hemodialysis. There were no significant correlations between plasma BPA level and several clinical parameters such as Kt/V, duration of hemodialysis, ultrafiltraion, blood flow, and age. CONCLUSION: Very small amounts of BPA were released from the cellulosynthetic hemodialyzer during a hemodialysis session. BPA doesn't seem to accumulate in the body of patients undergoing regular hemodialysis using cellulosynthetic hemodialyzer.

Effects of Individualized Education on Knowledge, Compliance, and Physiologic Parameters in Hemodialysis Patients / 성인간호학회지

PURPOSE: This study was designed to explore the effects of providing individualized education for hemodialysis patients on their knowledge of hemodialysis, compliance of patient role behavior, and physiologic parameters. METHOD: A quasi experimental design with a non-equivalent control group and a non-synchronized design was used. The experiment was conducted with a total of 40 hemodialysis patients (20 in the experimental group and 20 in the control group) at the artificial kidney center, C University Hospital. The experimental group was provided with individualized education, 30 minutes per session, three times per week, for two weeks. RESULTS: The experimental group had significantly higher knowledge of hemodialysis than the control group after the education. The compliance of patient role behavior was more enhanced in the experimental group than the control group. The experimental group showed significantly higher values of blood urea nitrogen, but not the values of blood creatinine, albumin, kalium, and phosphorus. CONCLUSION: The individualized education was found to be an effective intervention for improving patients' knowledge of hemodialysis and compliance of patient role behavior.

Moleculo-epidemiology of C hepatitis virus in artificial kidney dialysis patients, nemerous transfusion

On 332 blood sample of patients who underwent dialysis with many times of blood transfusion at the Institute of Hematology and blood transfusion, HCV infection was evaluated. Results showed the infection of C hepatits virus of 1a, 1b, 6, 6a genotypes. The infection was associated with the quality of transfused blood. Patients gender age occupation education level, the place where the procedure carried out, marital status, religion, ethnic group, the history of drug use… were not related factors.

Temporary Veno-venous Hemofiltration (TVVH) Using Low Flux Hemodialyzers / 대한신장학회잡지

BACKGROUND: Continuous veno-venous hemofiltration (CVVH) is one of the continuous renal replacement therapies for managing patients with refractory edema or oliguric renal failure with unstable vital signs. High-flux hemofilters are usually used for CVVH, but low-flux hemodialyzers are not used for CVVH. We tried temporary veno-venous hemofiltration (TVVH) procedures using low-flux hemodialyzers for 9 patients with acute or chronic renal failure who were on mechanical ventilation with positive end-expiratory pressure (PEEP) in the ICU. METHODS: All of the nine patients with acute or chronic oligo-anuric renal failure could not receive hemodialysis treatment in the hemodialysis room, because they were on mechanical ventilation with PEEP in the ICU due to severe fluid overload with elevated CVP and acute pulmonary edema. Low-flux hemodialyzers with effective membrane area of 1.0- 1.1 m2 and blood pumps on the discarded hemodialysis machines were used for TVVH procedures. RESULTS: Mean duration of TVVH was 17.0+/-16.7 hours and mean ultrafiltration rate was 440+/-203 mL/hour. After finishing the TVVH procedures, CVP decreased from 22.9+/-8.5 cmH2O to 6.4+/-2.4 cmH2O. Of nine patients, 6 patients (67%) were able to be off the mechanical ventilation with clinical improvement. CONCLUSION: Even if CVVH is usually done with expensive high-flux hemofilters and CVVH machines, simplified and cheaper TVVH procedures using low- flux hemodialyzers and discarded hemodialysis machines with functioning blood pumps can be done with good results and cost effectiveness, especially in institutions not equipped with facilities such as CVVH machines or portable water purification systems for hemodialysis in the ICU.

Characteristics in Nutritional Status of Patients on Hemodialysis and Continuous Ambulatory Peritoneal Patients in Chonbuk Area

The present study was designed to compare the nutritional status of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Subjects were 58 HD patients (male/female = 29/29) and 33 CAPD patients (male/female=23/10) undergoing dialysis treatment in Artificial Kidney Unit of Chonbuk National University Hospital. For nutritional assessment, %IBW (ideal body weight), %TSF (tricep skin fold), %MAC (mid arm circumference), %MAMC (mid arm muscle circumference), serum albumin, serum transferrin, TLC (total lymphocyte count), SGA (subjective global assessment) and estimated energy and protein intakes by 1-month food frequency method were used. Between HD and CAPD group, mean age (50+/-12 vs. 52+/-12 yr), dialysis durations (37+/-36 vs. 30+/-26 mon), dietary energy intakes (28.3+/-9.0 vs. 28.8+/-8.6 kcal/kg/day), dietary protein intakes (1.1+/-0.4 vs. 1.2+/-0.3 g/kg/day) and incidence of co-morbid conditions (69.0% vs. 69.7%) were not significantly different. Data by using SGA showed a higher incidence of malnutrition in CAPD patients (45.6%) than in HD patients (36.2%). %IBW (p<0.001), %TSF (p<0.001) and %MAC (p<0.001) were higher in CAPD patients than were in HD patients. But serum albumin (p<0.001) and transferrin (p<0.001) were significantly lower in CAPD patients than were in HD patients. A higher incidence of malnutrition was shown in CAPD Patients than in HD Patients due to different dialysis type. A significant finding was that CAPD showed protein deficient malnutrition and HD did calorie deficient malnutrition. It suggests that an adequate dietary intake considering dialysis type prevents a prevalence of malnutrition.

Application of tissue engineering in bioartificial renal tubule / 生物医学工程学杂志

Tissue engineering is a discipline involving both materials science, engineering and life science. It has found successful application in Bioartificial renal tubule assist device RAD which is still under development. Experiments have proved that RAD can serve as renal tubule to perform its transport, metabolic and endocrine functions in patients with acute or chronic renal failure.

Ethylene Oxide(EO) Induced Cutaneous Hypersensitivity in a Patient on Hemodialysis

A 46-year-old male patient had recurrent episodes of generalized pruritic wheals during hemodialysis. He has experienced urticaria during hemodialysis whenever he used a capillary dialyser sterilized by ethylene oxide(EO, Polysulfone-) gas which is used to sterilize hemodialysers and other medical equipment. On the other hand, capillary dialyser sterilized by Gamma ray (Hemophad) has not evoked urticaria. Although the presence of EO-specific antibodies was not detected, urticarial rash never developed when the equipment was switched to a gamma-sterilized one. We herein report a case referred to ethylene oxide induced cutaneous hypersensitivity during hemodialysis.

Primarily: findings of the efficacy of periodical hemodialysis according to the formula KT/V

The value of formula Kt/v has been calculated by Daurgidas method in order to assess the effectiveness of chronic hemodialysis on 22 patients from Dialysis Center of Friendship hospital. These patients had mean Kt/v=1.33, with range from 0.92 to 1.67. Patients with Kt/v value (1.33 seem to have better recovery ability. Good effect of dialysis, with Kt/v(1.33 could be achieved by two-session-per-week hemodialysis, using high efficiency dialyzes and with session lasting at least 5 hours

Púrpura de Schönlein-Henoch. Recidiva en el trasplante renal. Presentación de 1 caso / Schönlein-Henoch purpura. Recurrence in the kidney transplant. A case report

Se señaló que la afección renal marca el pronóstico en los pacientes con púrpura de Schönlein-Henoch, pero es rara en adultos y se reporta con poca frecuencia en los receptores de trasplante renal en estas edades. Se presentó el caso de una paciente con antecedentes de nefritis por púrpura de Schönlein-Henoch y pérdida de la función renal, con recidiva de dicha lesión en el riñón trasplantado, de una manera precoz e intensa. Se describió su evolución, hallazgos histológicos y biópsicos. Se comentaron algunas características de esta afección