Effect of reuse on dialyzer efficacy.

The effect of reuse on dialyzer efficacy was examined by measuring blood compartment volume and dialyzer mass transfer coefficient (maximum dialyzer clearance) as a function of dialyzer use number. The 102 polysulfone dialyzers tested (F60 and HF80, Fresenius) were reprocessed on Renatron machines using peroxyacetic acid as the dual cleansing and sterilizing agent. Each dialyzer was used an average of 14.4 +/- 5.7SD times and was tested once (twice for 13/102 dialyzers) during a routine dialysis session at an arbitrary use number (7.6 +/- 5.3; range 1 to 24). The parameters tested were found to decrease only marginally with reuse, corresponding to a blood compartment volume loss of approximately 1% (R = 0.04) over a 5-week/15-use period and a decrease in dialyzer mass transfer coefficient of approximately 3% (R = 0.07 and 0.06) over the same period for urea and creatinine, respectively. It was concluded that the loss in dialyzer efficacy is negligible over the average use period of almost 5 weeks per dialyzer.

Recombinant human erythropoietin: 18 months' experience in hemodialysis patients.

It has been shown that the regular administration of erythropoietin (EPO) permits the correction of anemia in end-stage renal failure patients. We analyzed the effect of chronic administration of EPO in 13 stable, regularly dialyzed end-stage renal failure patients over an 18-month period. The effects of EPO were evaluated according to standard criteria including clinical status, blood pressure control, hematology and biochemistry data, protein nutritional status, and dialysis efficiency. Following a 2-week control period, EPO was administered intravenously (IV) after the dialysis session according to a two-phase protocol. The first period (correction phase) consisted of a stepwise EPO dose increment, starting at 3 x 24 IU/kg/wk and doubling the dose every 14 days according to hemoglobin response in order to achieve a target hemoglobin level of approximately 11.0 g/dL (110 g/L). In the second period (maintenance phase) EPO dose was optimized to maintain the hemoglobin level between 100 and 110 g/L (10.0 and 11.0 g/dL), by adjusting either the unit dose or the frequency of injection. Anemia was corrected in all patients within 11 weeks, with EPO dose increasing from 72 to 360 IU/kg/wk. The stabilization of hemoglobin was achieved with an average EPO dose of 275 IU/kg/wk (50 to 476 IU/kg/wk). Concomitantly, a subjective and clinical improvement was noted in all patients. The dialysis efficacy remained in an acceptable range throughout the study, falling significantly (approximately 10%) through the first 3 months of treatment to stabilize at an effective urea clearance of approximately 120 L/wk. The dietary protein intake calculated from urea kinetic modeling ranged between 1.1 and 1.2 g/kg/d.(ABSTRACT TRUNCATED AT 250 WORDS)

[Recombinant human erythropoietin: 18 months of continuous use in substitution hemodialysis]. / Erythropoïétine humaine recombinante: 18 mois d'utilisation continue en hémodialyse de suppléance.

It has been shown that the regular administration of EPO permits the correction of anemia in end stage renal failure patients. We analyzed the effect of chronic administration of EPO in 13 stable, regularly-dialysed end stage renal failure patients over an 18 month period. The effects of EPO were evaluated according to standard criteria including clinical status, blood pressure control, hematology and biochemistry data, protein nutritional status and dialysis efficiency. Following a 2 week control period, EPO was administered intravenously after the dialysis session according to a 2 phase protocol. The first period (correction phase) consisted of a stepwise EPO dose increment, starting at 24 IU/kg x 3 times and doubling the dose every 14 days according to hemoglobin response in order to achieve a target hemoglobin level of 11 g/dl. In the second period (maintenance phase) EPO dose was optimized to maintain the hemoglobin level between 10 and 11 g/dl, by adjusting either the dose or the frequency of injection. Anemia was corrected in all patients within 10 weeks with EPO dose increasing from 72 to 360 IU/kg/week. The stabilisation of hemoglobin was achieved with an average EPO dose of 275 IU/kg/week (50 to 476 IU/kg/week). Concomitantly, a subjective and clinical improvement was noted in all patients. The dialysis efficacy, although remaining in an acceptable range, fell significantly by 10% over the first 3 months of treatment, remaining stable afterwards, yielding an effective urea clearance near to 120 1/week. The dietary protein intake calculated from urea kinetic modelling ranged between 1.1 and 1.2 g/kg/day.(ABSTRACT TRUNCATED AT 250 WORDS)