Clearance of gentamicin during hemodialysis: comparison of four artificial kidneys.

The effects of four types of artificial kidney on dialyzer clearance rates and serum pharmacokinetics of gentamicin were compared. In 19 patients undergoing chronic hemodialysis, the mean (+/-SE) interdialysis half-life of gentamicin in serum was 49.3 +/- 3.5 hr, whereas during dialysis this value was reduced to 10.0 +/- 0.7 hr. The mean half-life of gentamicin in serum at conventional flow rates for the Hollow Fiber Kidney, Kiil, Gambro, and Coil dialyzers was 11.3, 10.9, 8.2, and 7.4 hr, respectively, and the mean values for clearance of gentamicin were 26,28,42, and 48 ml per min, respectively. For all dialyzers, rates of clearance of gentamicin increased linearly with plasma flow rate over the flow range studied. The Gambro and Coil dialyzers had significantly higher rates of clearance of gentamicin from serum (P less than 0.05) than the Hollow Fiber Kidney and Kiil dialyzers over a wide range of clinically useful plasma flow rates (119-300 ml per min), whereas the Kiil dialyzer cleared gentamicin more effectively (P less than 0.05) than the Hollow Fiber Kidney dialyzer over a more limited interval (117-177 ml per min). Therapeutic recommendations for patients undergoing hemodialysis were made in light of current findings.

Initial approach to blood access for the chronic hemodialysis patient--the bovine heterograft.

Experience with the modified bovine heterograft arteriovenous fistula for hemodialysis in 79 grafts in 73 patients over an 18 mo period is analyzed. An immediate (30 day) patency rate of 97.5%, and a 12 mo cumulative patency rate of 73.9% was observed. Early and late complication rates were acceptably low, despite early usage in 80% of cases. It is concluded that the bovine fistula provides an acceptable blood access route for the initial approach to the patient in urgent need of hemodialysis.