[Continuous detoxication methods in acute kidney failure]. / Nepreryvnye metody detoksikatsii pri ostroi pochechnoi nedostatochnosti.

Recently, acute renal failure has often been managed with continuous extracorporeal detoxication of the blood. In this case detoxication unit worked for days or even weeks. The continuous detoxication (CD) has the advantages: no sharp homeostatic changes occur, blood detoxication covers the whole period of acute renal failure. Technical specifications of the equipment are provided, as well as the diseases most responding to CD and recommendations on anticoagulation and replacement of the lost amino acids and glucose. CD allows the physicians to adjust therapeutic scheme to current needs of the patient.

[The mathematical modelling of water-osmotic equilibrium during the performance of hemodialysis]. / Matematicheskoe modelirovanie vodno-osmoticheskogo ravnovesiia vo vremia provedeniia gemodializa.

The model has been designed by the authors to prevent complications as a result of redistribution of liquid between cellular and extracellular spaces arising in the patient's body in the course of hemodialysis. Because movements of the liquid between the spaces depends on the osmolality gradient, two principal systems were identified: body water system and system of osmotically active substances. The latter incorporates sodium and potassium salts and urea. The model is based on 6 differential equations. The least squares method derived individual parameters of the model. Using the model, the physician can regulate to optimal the regimen of hemodialysis: blood flow rate, speed of ultrafiltration, concentration of sodium and potassium in dialysate.

[Beta 2-microglobulin kinetics during hemodialysis with different membranes]. / Kinetika beta 2-mikroglobulina vo vremia gemodializa s razlichnymi membranami.

Dialysers F6 (polysulphon membrane) and Altra Nova-170 (acetate cellulose-H membrane) were tested for effects on concentration of beta 2-microglobulin (beta-2 MG) in the course of hemodialysis. F6 produced a rise in beta-2 MG levels (50.0 +/- 7.7 to 59.2 +/- 9.5 mg/l). Altra Nova-170 induced no significant changes in these levels. Dialyser F6 seems to stimulate generation or release of beta-2 MG the input and output amounts of which indicate that the process may be confined to dialyser interior. On hemodialysis minute 15 a sharp fall in beta-2 MG concentrations was registered in the use of either device. This phenomenon resembles leukopenic effect of cellulose membranes. Hemodialysis kinetics of beta-2 MG is likely to depend on leukocyte activation.

[The role of the phenomenon of the redistribution of aminoglycosides in their monitoring and dosage calculation in patients in the terminal stage of kidney failure undergoing systematic hemodialysis treatment]. / Rol' fenomena pereraspredeleniia aminoglikozidov v ikh monitoringe i raschete doz u bol'nykh s terminal'noi stadiei pochechnoi nedostatochnosti, nakhodiashchikhsia na lechenii sistematicheskim gemodializom.

The kinetics of aminoglycosides (amikacin, netilmycin, gentamicin, tobramycin) were investigated in patients with end-stage renal disease who were on systemic hemodialysis. Their decrease in the blood revealed in pre-dialysis and dialysis periods was exponential. After dialysis termination there was a gradual aminoglycoside increase as compared to the end-dialysis period, which was of linear character and depended on the degree of these agents' dialysis clearance. The cause of the phenomenon is likely to be higher aminoglycoside blood elimination rate than their entering the blood from tissues. A method is proposed to calculate an additional dose of aminoglycosides, taking into account their higher concentrations in the postdialysis period, under permanent monitoring of their blood levels.

[Changes in the beta 2-microglobulin level during hemodialysis]. / Izmenenie urovnia beta 2-mikroglobulina vo vremia gemodializa.

The authors studied changes of the beta 2-microglobulin level during hemodialysis with dialyzers AIP-02-02 (cuprophane membrane), E2 (cuprophane membrane), AIP-03-02 (polysulfone membrane), F60 (polysulfone membrane), and hemodiafiltration with dialyzer F60. The following data were obtained. The beta 2-microglobulin level in patients undergoing hemodialysis is approximately 20 times the normal level. No essential fluctuations of the level of this protein occurs during hemodialysis and hemodiafiltration. The cuprophane membrane does not cause increase of beta 2-microglobulin generation during hemodialysis. Standard hemodialysis with the cuprophane membrane and the highly-permeable polysulfone membrane does not lead to decrease of the beta 2-microglobulin level. Hemodiafiltration with the highly-permeable polysulfone membrane is an effective method for the elimination of this protein.

[The effect of heparin on the lipid level during hemodialysis]. / Vliianie geparina na uroven' lipidov vo vremia gemodializa.

The level of free fatty acids, triglycerides, and total lipids was studied in dynamics during hemodialysis. At the beginning of hemodialysis, fatty acids are discharged into the blood flow and their level at 20 min of hemodialysis is three-fold the initial level. Plasma triglycerides, which are components of lipoproteins, are the source of the discharge of free fatty acids. This is confirmed by the fact that the triglyceride content reduces simultaneously with the increase in the level of free fatty acids. The concentration of total lipids practically does not change during hemodialysis. The possible significance of a sharp increase of the free fatty acid level during hemodialysis is discussed.

[The effect of hemodialysis on lipid peroxidation]. / Vliianie gemodializa na perekisnoe okislenie lipidov.

With regard to the variance in the levels of lipid peroxidation products (malonic dialdehyde and diene conjugates) the authors studied the impact of hemodialysis on lipid peroxidation. Transitory activation of lipid peroxidation with a subsequent decrease in the levels of lipid peroxidation products that were lower than initial ones were noted at the initial stages of hemodialysis performed with the use of a DEP-02-02 dialyzer (with a cuprophane membrane). The comparison of the input and output levels of lipid peroxidation products failed to demonstrate any generation of lipid peroxidation products inside the dialyzer. The systemic character of the activation effect in the onset of dialysis was established. It was proved that the effect did not depend on the material used for the membrane as there was no rise in the levels of lipid peroxidation products but a decrease in their concentration when the capillary dialyzers D1 and B2-100 were used. The study of the washings from the cuprophane membrane from the dialyzer DEP-02-02 demonstrated high levels of endotoxin which were several times higher than in those from the same membrane from the dialyzer D2. Endotoxin release into the circulation probably determined the transitory effect of the activation in the onset of the procedure performed with the dialyzer DEP-02-02. The authors discussed the possible origin of high initial levels of lipid peroxidation products observed in patients with terminal chronic renal failure who had undergone hemodialysis.

[Reprocessing of capillary dialyzers]. / Reprotsessing kapilliarnykh dializatorov.

Changes in biocompatibility parameters of the cuprophan membrane, used repeatedly after reprocessing, were assessed. It is demonstrated that when the dialyzer is applied for the second of third time, cuprophan membrane loses its ability to induce acute dialysis leucopenia, typical for first application. Repeatedly used dialyzers also failed to cause bone-marrow irritation, which at first use induced a release of juvenile neutrophils into the circulation. Prior to first application, 6 dialyzers were subjected to 3 reprocessing procedures each. In all three, the cellulose membrane did not lose its ability to cause acute leucopenia. Therefore, the chemical reagents used in reprocessing (hydrogen peroxide, sodium hypochlorite and formaldehyde) are not the cause of membrane's loss of ability to induce leucopenia. Used for 3 times running, capillary dialyzers do not essentially lose their effective capillary volume. To determine whether the dialyzer is suitable for repeated use, both visual and objective check-up of the device is necessary. Some aspects of reprocessing technology are discussed.

[Activation of monocytes during hemodialysis]. / Aktivatsiia monotsitov vo vremia gemodializa.

The authors conducted a clinical study of the hypothesis of interleukin-1 regarded as one of the most important topics in the problem of biocompatibility of dialytic membranes. Hemodialyses (HD) were performed using different cellulose and synthetic membranes. During HD research was made into the kinetics of monocytes and lymphocytes, monocytic activation expressed by a stimulation index, and the deposition of blood elements on the membranes of parallel membrane dialysers. All types of cellulose membranes were characterized by acute dialytic monocytopenia. Synthetic membranes produced no considerable monocytopenia. No convincing data on the dependence of the monocytic stimulation effect on membrane material were obtained. Possible mechanisms of monocytic activation during HD were discussed.