Estimating Dietary Protein and Sodium Intake with Sodium Removal in Peritoneal Dialysis Patients.

An increase in dietary protein intake (DPI) carries a risk with respect to increased sodium intake, which further leads to the development of cardiovascular morbidity in peritoneal dialysis (PD) patients. Dialytic (DSR) and urinary sodium removal (USR) are potential indicators of sodium intake. In this single-center cross-sectional study with 60 prevalent PD patients, we analyze the correlation of DPI with sodium intake and the association between residual renal function (RRF) and comorbidity grade, expressed as the Davies score with sodium removal and protein metabolism indices such as normalized protein catabolic rate (nPCR) and lean body mass (LBM). The value of RRF < 2 mL/min/1.73 m2 is significantly associated with lower USR (p = 0.000) and lower %LBM (p < 0.001). The greatest USR is detected in patients with low Davies comorbidity grade (p = 0.018). Compared to patients with DPI < 0.8 g/kg/day, patients with DPI > 0.8 g/kg/day have a greater sodium intake (3.69 ± 0.71 vs. 2.94 ± 0.86; p < 0.018) and a greater nPCR (p < 0.001). Protein intake is significantly correlated with sodium intake (p = 0.041), but not with total sodium removal (TSR). A strong correlation is observed between sodium intake and TSR (p = 0.000), although single TSR values are not the same as the corresponding sodium intake values. An increasing protein intake implies the necessity to determine both sodium intake and sodium removal. Preservation of RRF has a beneficial role not just in sodium removal, but also in the increase of LBM.

Can one long peritoneal dwell with icodextrin replace two short dwells with glucose?

Background: Due to the slower dissipation of the osmotic gradient, icodextrin-based solutions, compared to glucose-based solutions, can improve water removal. We investigated scenarios where one icodextrin-based long dwell (Extraneal) replaced two glucose-based exchanges. Methods: The three-pore model with icodextrin hydrolysis was used for numerical simulations of a single exchange to investigate the impact of different peritoneal dialysis schedules on fluid and solute removal in patients with different peritoneal solute transfer rates (PSTRs). We evaluated water removal (ultrafiltration, UF), absorbed mass of glucose (AbsGluc) and carbohydrates (AbsCHO, for glucose and glucose polymers), ultrafiltration efficiency (UFE = UF/AbsCHO) per exchange, and specified dwell time, and removed solute mass for sodium (ReNa), urea (ReU), and creatinine (ReCr) for a single peritoneal exchange with 7.5% icodextrin (Extraneal®) and glucose-based solutions (1.36% and 2.27%) and various dwell durations in patients with fast and average PSTRs. Results: Introducing 7.5% icodextrin for the long dwell to replace one of three or four glucose-based exchanges per day leads to increased fluid and solute removal and higher UF efficiency for studied transport groups. Replacing two glucose-based exchanges with one icodextrin exchange provides higher or similar water removal and higher daily sodium removal but slightly lower daily removal of urea and creatinine, irrespective of the transport type present in the case of reference prescription with three and four daily exchanges. Conclusion: One 7.5% icodextrin can replace two glucose solutions. Unlike glucose-based solutions, it resulted only in minor differences between PSTR groups in terms of water and solute removal with UFE remaining stable up to 16 h.

Sodium removal per ultrafiltration volume in automated peritoneal dialysis in pediatric patients.

BACKGROUND: The standard rate of sodium removal in adult anuric patients on continuous ambulatory peritoneal dialysis (CAPD) is 7.5 g/L of ultrafiltration volume (UFV). Although automated PD (APD) is widely used in pediatric patients, no attempt has yet been made to estimate sodium removal in APD. METHODS: The present, retrospective cohort study included pediatric patients with APD who were managed at Tokyo Metropolitan Children's Medical Center between July 2010 and November 2017. The patients underwent a peritoneal equilibrium test (PET) at our hospital. Sodium removal per UFV was calculated by peritoneal function and dwell time using samples from patients on APD with 1- and 2-h dwell effluent within three months of PET and 4- and 10-h dwell effluent at PET. RESULTS: In total, 217 samples from 18 patients were included, with 63, 81, and 73 of the samples corresponding to the High [H], High-average [HA], and Low-average [LA] PET category, respectively. Sodium removal per UFV (g/L in salt equivalent) for dwell times of one, two, four, and ten hours was 5.2, 8.8, 8.0, and 11.5 for PET [H], 5.3, 5.8, 5.6, and 8.1 for PET [HA], and 4.6, 5.1, 5.1, and 7.1 for PET [LA], respectively. CONCLUSIONS: Sodium removal per UFV in pediatric APD was less than the standard adult CAPD and tended to be lower with shorter dwell times, leading to sodium accumulation. Therefore, salt intake should be restricted in combination with one or more long daytime dwells, especially in anuric patients.

Peritoneal and Urinary Sodium Removal in Refractory Congestive Heart Failure Patients Included in an Ambulatory Peritoneal Dialysis Program: Valuable for Monitoring the Course of the Disease.

INTRODUCTION: Spot urinary sodium emerged as a useful parameter for assessing decongestion in patients with congestive heart failure (CHF). Growing evidence endorses the therapeutic role of continuous ambulatory peritoneal dialysis (CAPD) in patients with refractory CHF and kidney disease. We aimed to examine the long-term trajectory of urinary, peritoneal, and total (urinary plus peritoneal) sodium removal in a cohort of patients with refractory CHF enrolled in a CAPD program. Additionally, we explored whether sodium removal was associated with the risk of long-term mortality and episodes of worsening heart failure (WHF). METHODS: We included 66 ambulatory patients with refractory CHF enrolled in a CAPD program in a single teaching center. 24-h peritoneal, urinary, and total sodium elimination were analyzed at baseline and after CAPD initiation. Its trajectories over time were calculated using joint modeling of longitudinal and survival data. Within the framework of joint frailty models for recurrent and terminal events, we estimated its prognostic effect on recurrent episodes of WHF. RESULTS: At the time of enrollment, the mean age and estimated glomerular filtration rate were 72.8 ± 8.4 years and 28.5 ± 14.3 mL/min/1.73 m2, respectively. The median urinary sodium at baseline was 2.34 g/day (1.40-3.55). At a median (p25%-p75%) follow-up of 2.93 (1.93-3.72) years, we registered 0.28 deaths and 0.24 episodes of WHF per 1 person-year. Compared to baseline (urinary), CAPD led to increased sodium excretion (urinary plus dialyzed) since the first follow-up visit (p < 0.001). Over the follow-up, repeated measurements of total sodium removal were associated with a lower risk of death and episodes of WHF. CONCLUSIONS: CAPD increased sodium removal in patients with refractory CHF. Elevated sodium removal identified those patients with a lower risk of death and episodes of WHF.

Nano-hydroxyapatite/carbon nanotube: An excellent anode modifying material for improving the power output and diclofenac sodium removal of microbial fuel cells.

Anode material and surface properties have a crucial impact on the performance of MFCs. Designing and fabricating various modified carbon-based anodes with functional materials is an effective strategy to improve anode performance in MFCs. Anode materials with excellent bioaffinity can promote bacterial attachment, growth, and extracellular electron transfer. In this study, positively charged nano hydroxyapatite (nHA) with remarkable biocompatibility combined with carbon nanotubes (CNTs) with unique structure and high conductivity were used as anode modifying material. The nHA/CNTs modified carbon brush (CB) exhibited improved bacteria adsorption capacity, electrochemical activity and reticular porous structure, thus providing abundant sites and biocompatible microenvironment for the attachment and growth of functional microbial and accelerating extracellular electron transfer. Consequently, the nHA/CNTs/CB-MFCs achieved the maximum power density of 4.50 ± 0.23 mW m-2, which was 1.93 times higher than that of the CB-MFCs. Furthermore, diclofenac sodium (DS), which is a widely used anti-inflammatory drug and is also a persistent toxic organic pollutant constituting a serious threat to public health, was used as the model organic pollutant. After 322 days of long-term operation, enhanced diclofenac sodium removal efficiency and simultaneous bioelectricity generation were realized in nHA/CNTs/CB-MFCs, benefiting from the mature biofilm and the diverse functional microorganisms revealed by microbial community analysis. The nHA/CNTs/CB anode with outstanding bioaffinity, electrochemical activity and porous structure presents great potential for the fabrication of high-performance anodes in MFCs.

Removal of Sodium from Vanadium Tailings by Calcification Roasting in Reducing Atmosphere.

Vanadium tailings from vanadium extraction by a sodium roasting process are solid waste and cannot be used in sintering and ironmaking due to their high sodium content. In this paper, a calcification and reduction roasting process was proposed to remove sodium from vanadium tailings. The effects of Ca(OH)2 addition, reduction temperature, and roasting time on the sodium removal behavior and compression strength of pellets were studied. The addition of Ca(OH)2 and the reduction of iron oxides promoted the sodium-containing phases to transform to be simpler, which could enhance sodium removal. The sodium removal rate was up to 93.47% and the compression strength of the reduced products was 4497 N/P, and the metallized ratio of the product was higher than 70% under the optimal conditions: roasting at 1200 °C for 2 h with the Ca(OH)2 addition of 35%. The treated product after removing sodium can be recycled in the ironmaking process in a steel company.

Simultaneous phosphate recovery and sodium removal from brackish aquaculture effluent via diafiltration-nanofiltration process.

Expansion of the aquaculture industry has been accompanied by environmental impact as the discharged effluent contains excess nutrients such as phosphorus compounds. Recovery of such nutrients is not economically feasible as it presents in trace amounts. Furthermore, brackish aquaculture effluent which contains high sodium chloride (NaCl) content makes the treated solution inappropriate for fertilizer production. Herein, this study proposed a diafiltration-nanofiltration route to perform a simultaneous phosphate concentrating and osmotion (sodium) removal from brackish aquaculture effluent. Effects of operating pressure, phosphate, and sodium content on membrane performance were first determined using Desal-5 DK membrane with three types of solutions namely (i) freshwater without NaCl, (ii) dilute brackish water with 1,500 mg/L NaCl, and (iii) brackish water with 10,000 mg/L NaCl. It was found that at 4 bar operating pressure, it could achieve higher phosphate rejection and sodium permeance. The presence of NaCl negatively influenced both phosphate rejection and concentrating factor (CF) due to the salt screening effect. It was noteworthy that negative sodium rejection (up to -16%, CF <1) could be attained, indicating the concentrating effect for sodium was negligible. The concentrating process was effective to concentrate phosphate by 2-fold but less effective in removing sodium. Diafiltration was then introduced and resulted in about 76% of sodium removal. Diafiltration-nanofiltration (DF-NF) mode was shown to be a more efficient method than nanofiltration-diafiltration (NF-DF) mode as phosphate could be concentrated up to 2 factors with 99 wt% of sodium being removed from the real brackish aquaculture effluent. These findings showed that DF-NF is a feasible approach for concentrating phosphate while removing sodium ions from aquaculture effluent and the recovered nutrient solution has huge potential to be applied as liquid fertilizer for hydroponic plants.

Research on Bayer Red Mud Slurry Electrolysis.

The Bayer red mud is the solid waste generated during the production of alumina by the Bayer process. At present, the stock of red mud in China exceeds 1.1 billion tons, covering an area of more than 120,000 mu, and the annual production volume is increasing by 100 million tons. The comprehensive utilization of red mud is still a difficult problem. Therefore, it is of great significance to actively explore new methods for removing sodium from red mud. In this study, the traditional red mud desalination process and the slurry electrolysis process are combined, and the influence of three different leaching agents on the leaching and sodium removal of red mud slurry in the presence of an electric field is explored. In the slurry electrolysis experiment, it was found that the sodium removal rate obtained by different leaching agents was CaO > CaCl2 > HCl. The red mud leached with pure dilute hydrochloric acid has the highest Na removal rate, which is 93.11%. In view of this situation, a pre-slurry-electrolysis cycle process with HCl as leaching agent was proposed. The core of slurry electrolysis is electrolyzing NaCl solution, and HCl only participates in the process as circulating medium. The design of this process reduces cost and increases efficiency.

Peritoneal dialysis effluent-derived exosomal miR-432-5p: an assessment tool for peritoneal dialysis efficacy.

Background: Ultrafiltration (UF) volume and peritoneal solute transport rate (PSTR) are common parameters used to evaluate the efficacy of peritoneal dialysis (PD) on individual patients. It is unclear whether the level of exosomal microRNA (miRNA) in peritoneal dialysis effluent (PDE) can predict UF or PSTR. This study was designed to investigate if there is a correlation between PDE exosomal miRNA (miR-432-5p) levels and various UF volumes and PSTRs in PD patients. It also aimed to explore the underlying mechanism of water and dialytic sodium removal (DSR). Methods: The PSTR was quantified using the 4-hour (4 h) 3.86% dialysate to plasma creatinine ratio. The PDE exosomes (PDE-exo) were isolated by ultracentrifugation. An miRNA assay was used to identify the different miRNA in the PDE-exo of patients in a high (H; PSTR >0.65, n=5) and low (L; PSTR <0.65, n=5) group. We focused on miR-432-5p as bioinformatic analysis had shown that it could be involved in sodium transport. We used mimic/inhibitor transfection and dual luciferase reporter assay to verify the target genes of miR-432-5p. We used PKH-67 stained PDE-exo to observe their interaction with human MeT-5A mesothelial cells. Results: Our results showed that the PDE-exo-miR-432-5p level was higher in group H than in group L. The levels of PDE-exo-miR-432-5p were positively correlated with PSTR (r=0.391; P<0.05; n=40) and negatively correlated with the 4 h UF volume (r=-0.376; P<0.05; n=40) and 4 h DSR (r=-0.535; P<0.01; n=24). Epithelial sodium channel α subunit (α-ENaC) was revealed as a direct target gene of miR-432-5p and expressed on both human peritoneum and MeT-5A cells. Furthermore, we found the PKH67 labeled-PDE-exo could be internalized into MeT-5A cells. Conclusions: A high PDE-exo-miR-432-5p level was associated with poor UF volume and DSR. It may be that PDE-exo-miR-432-5p affects DSR through downregulating α-ENaC expression.

Competitive adsorption of pollutants from anodizing wastewaters to promote water reuse.

Anodizing wastewater contains principally phosphate (PO43-) anions according to previous studies, but with the purpose to promote water reuse in this type of industry, a complete characterization of wastewater was made to remove other anions and cations also present in significant concentration. Particularly, the adsorption of sodium (Na+), potassium (K+), fluoride (F-), sulfate (SO42-) and phosphate (PO43-) was studied using different sorbents such as: coconut shell activated carbon, bone char, bituminous coal activated carbon, natural zeolite, silica, anionic and cationic exchange resins, a coated manganese-calcium zeolite, coconut shell activated carbon containing iron and iron hydroxide. All sorbents were characterized using FT-IR spectroscopy, potentiometric titration, nitrogen adsorption isotherms at 77 K, X-ray diffraction and SEM/EDX analysis to study the adsorption mechanism. The adsorption studies were performed in batch systems under constant agitation using both standard solutions of each ion and real anodizing wastewater. Results showed that, in general, the adsorption of all anions and cations is higher when mono-component standard solutions were used, since in the anodizing wastewater all species are competing for the active sites of the adsorbent. Na+ present in anodizing wastewater was efficiently adsorbed on coated manganese-calcium zeolite (20.55 mg/g) and natural zeolite (18.55 mg/g); while K+ was poorly adsorbed on all sorbents (less than 0.20 mg/g). Anions such as F-, SO42- and PO43-, were better adsorbed on the anionic resin (0.17, 45.38 and 2.92 mg/g, respectively), the iron hydroxide (0.14, 7.96 and 2.87 mg/g, respectively) and the bone char (0.34, 8.71 and 0.27 mg/g, respectively). All these results suggest that adsorption is a promising tertiary treatment method to achieve water reuse in the anodizing industry.

Characterization of sodium removal to ultrafiltration volume in a peritoneal dialysis outpatient cohort.

BACKGROUND: Failure to control volume is the second most common cause of peritoneal dialysis (PD) technique failure. Sodium is primarily removed by convection, but according to the three-pore model, water and sodium movements are not necessarily concordant. We wished to determine factors increasing sodium to water clearance in clinical practice. METHODS: We reviewed 24-h peritoneal dialytic sodium removal (DSR) and ultrafiltration (UF) volume in consecutive PD patients attending for routine assessment of peritoneal membrane function and adequacy testing. We used a regression model with the DSR/UF ratio as the dependent variable. A second model with DSR as the dependent variable and interaction testing for UF was used as sensitivity analysis. RESULTS: We included 718 adult PD patients. Mean values were 51.8 ± 64.6 mmol/day and 512 ± 517 mL/day for DSR and UF, respectively. In multivariable analysis, DSR/UF ratio was positively associated with transport type (fast versus slow, P < 0.001), serum sodium (P < 0.001) and diabetes (P = 0.026), and negatively associated with PD mode [automated PD versus continuous ambulatory PD (CAPD), P < 0.001] and the use of 2.27% glucose dialysate (P < 0.001). Sensitivity analysis showed positive interaction with UF for transport type (P < 0.001) and serum sodium (P = 0.032) and negative interaction for PD mode (P < 0.001) and cycles number (P < 0.001). CONCLUSIONS: CAPD, fast transport and high serum sodium allow relatively more sodium to be removed compared with water. Icodextrin has no effect on sodium removal once confounders have been accounted for. Although widely used in the assessment of PD patients, UF should not be considered as a surrogate for DSR in clinical practice.

Decorating graphene oxide with zeolitic imidazolate framework (ZIF-8) and pseudo-boehmite offers ultra-high adsorption capacity of diclofenac in hospital effluents.

This study reports on an easy and scalable synthesis method of a novel magnetic nanocomposite (GO/ZIF-8/γ-AlOOH) based on graphene oxide (GO) nanosheets decorated with zeolitic imidazolate framework-8 (ZIF-8), pseudo-boehmite (γ-AlOOH), and iron oxide (Fe3O4) nanoparticles by combining solvothermal and solid-state dispersion (SSD) methods. The nanocomposite was successfully applied to remove of diclofenac sodium (DCF) - a widely used pharmaceutical - from water. Response Surface Methodology (RSM) was used to optimize the adsorption process and assess the interactions among the influencing factors on DCF removal efficiency; including contact time, adsorbent dosage, initial pH, solution temperature, and DCF concentration. Adsorption isotherm results showed a good fitting with the Langmuir isotherm model with an exceptional adsorption capacity value of 2594 mg g-1 at 30 °C, which was highly superior to the previously reported adsorbents. In addition, kinetic and thermodynamic investigations further illustrated that the adsorption process was fast (equilibrium time = 50 min) and endothermic. The regeneration of GO/ZIF-8/γ-AlOOH nanocomposite using acetic acid solution (10% v/v) after a simple magnetic separation was confirmed in five consecutive cycles, which eliminate the usage of organic solvents. The nanocomposite has also shown a superior performance in treating a simulated hospital effluent that contained various pharmaceuticals as well as other organic, and inorganic constituents.

Modification of Cation-Exchange Membranes with Polyelectrolyte Multilayers to Tune Ion Selectivity in Capacitive Deionization.

Capacitive deionization (CDI) is a desalination technique that can be applied for the separation of target ions from water streams. For instance, mono- and divalent cation selectivities were studied by other research groups in the context of water softening. Another focus is on removing Na+ from recirculated irrigation water (IW) in greenhouses, aiming to maintain nutrients. This is important as an excess of Na+ has toxic effects on plant growth by decreasing the uptake of other nutrients. In this study, we investigated the selective separation of sodium (Na+) and magnesium (Mg2+) in MCDI using a polyelectrolyte multilayer (PEM) on a standard grade cation-exchange membrane (Neosepta, CMX). Alternating layers of poly(allylamine hydrochloride) (PAH) and poly(styrene sulfonate) (PSS) were coated on a CMX membrane (CMX-PEM) using the layer-by-layer (LbL) technique. The layer formation was examined with X-ray photoelectron spectroscopy (XPS) and static water contact angle measurements (SWA) for each layer. For each membrane, i.e., the CMX-PEM membrane, CMX membrane, and for a special-grade cation-exchange membrane (Neosepta, CIMS), the Na+/Mg2+ selectivity was investigated by performing MCDI experiments, and selectivity values of 2.8 ± 0.2, 0.5 ± 0.04, and 0.4 ± 0.1 were found, respectively, over up to 40 cycles. These selectivity values indicate flexible switching from a Mg2+-selective membrane to a Na+-selective membrane by straightforward modification with a PEM. We anticipate that our modular functionalization method may facilitate the further development of ion-selective membranes and electrodes.

Synthesis of chitosan composite iron nanoparticles for removal of diclofenac sodium drug residue in water.

Iron composite nanoparticles were prepared (90% yield) using macromolecule chitosan and characterized by spectroscopic techniques (FT-IR, XRD, SEM, TEM & EDX). These were utilized to remove diclofenac sodium in water. The adjusted parameters were 400 µg/ L, 50.0 min., 5.0, 2.0 g/ L and 25.0 °C as concentration, contact time, pH, adsorbent amount and temperature for the elimination of diclofenac sodium in water with maximum 85% elimination. The sorption was spontaneous with exothermic. Data followed Langmuir, Temkin and Dubinin-Radushkevich models. Thermodynamic parameter ΔG° values were -12.19, -13.74 and -15.67 kJ/mol at 20, 25 and 30 °C temperatures. The values of ΔH° and ΔS° were 8.58 and 20.84 kJ/mol. Pseudo-first-order and liquid film diffusion mechanisms were proposed for the adsorption. This adsorption method is fast, effective eco-friendly and low-cost as it may be used in natural circumstances of water resources. The sorption method may be applied for the elimination of diclofenac sodium in any water body at a huge and financial scale.

Adjustment of automated peritoneal dialysis prescription based on volume management / 中华全科医师杂志

Volume management is recognized as an important determinant of dialysis adequacy. The optimal ultrafiltration and sodium removal will improve the volume management and reduce the cardiovascular mortality. Automated peritoneal dialysis (APD), as one of renal replacement therapies, has become a choice for more and more patients with end-stage renal disease. APD allows an individualized dialysis prescription by providing more dialysis doses and more exchange times to improve ultrafiltration and sodium removal, achieving or even exceeding the efficacy of continuous ambulatory peritoneal dialysis. New strategies for volume control have emerged, including adapted APD, using icodextrin and low-sodium dialysate, to provide new ideas for APD prescription adjustment.

Sodium removal and plasma tonicity balance are not different in hemodialysis and hemodiafiltration using high-flux membranes.

BACKGROUND: The clinical benefits of on-line hemodiafiltration (HDF) versus high-flux membranes hemodialysis (hf-HD) are still debated. In fact, although a superiority of one treatment over the other, especially in terms of mortality, did not emerge from the analysis of clinical trials, improved intradialytic vascular stability and cardiovascular mortality have been observed in patients undergoing HDF rather than hf-HD; the lower removal of sodium (Na+) during HDF seems to play a major role. The plasma concentration of Na+ is the major determinant of plasma tonicity, which, by determining the flow of water between the intracellular and the extracellular compartment, contributes to the vascular refilling process and the maintenance of blood pressure during the hemodialysis treatment. Plasma tonicity also depends on plasma glucose concentration, especially in patients with diabetes mellitus with hyperglycaemia at the start of hemodialysis treatment. MATERIALS AND METHODS: We evaluated the removal of Na+ and plasma tonicity balance during a 2-week period by performing 2-3 consecutive sessions of hf-HD followed by 2-3 consecutive sessions of HDF, or vice versa, in 47 patients (40% diabetics) on chronic hemodialysis. Identical parameters were used in all dialytic sessions. RESULTS: Na+ removal per session was - 224 ± 144 mmol and - 219 ± 152 mmol, respectively, in hf-HD and in HDF (p = 0.79). The plasma tonicity balance per session was - 575 ± 310 mOsm and - 563 ± 328 mOsm, respectively, in hf-HD and in HDF (p = 0.75). CONCLUSIONS: The removal of Na+ and plasma tonicity balance did not differ between hf-HD and HDF. This observation suggests that factors other than those assessed in our study might explain the improved cardiovascular stability reported in HDF.

Sodium removal by peritoneal dialysis: a systematic review and meta-analysis.

Achievement of sodium and fluid balance is considered a major determinant of dialysis adequacy in peritoneal dialysis (PD). However, the contribution of different PD modalities to dialytic sodium removal (DSR) remains ill-defined. We performed a systematic review and meta-analysis to compare DSR by manual (continuous ambulatory PD, CAPD) versus automated PD (APD). Alternative PD strategies to remove sodium were also analyzed. Seven cohort studies, including 683 patients, 406 in CAPD and 277 in APD, were meta-analyzed out of the 30 studies selected based on DSR data availability. Overall, the unstandardized mean difference between CAPD and APD was significant [- 56 mmol/day (95% CI - 106, - 6), p = 0.027]. Heterogeneity was high (I2 87.2%; p < 0.001). Meta-regression showed a strict correlation of DSR difference with creatinine dialysate/plasma ratio (D/P) (p = 0.04). DSR was significantly lower in APD than CAPD [86.2 (57.3-115.1) vs. 141.3 (107.6-174.9) mmol/day, p = 0.015]. Conversely, ultrafiltration (UF) did not differ [1122.6 (891.2-1354.0) in CAPD and 893.6 (823.0-964.2) ml/day in APD, p = 0.064]. A very strong correlation between DSR and achieved UF was found in CAPD (R = 0.94; p < 0001) while no relationship was detected in APD (R = - 0.07; p = 0.85). CAPD allows a higher DSR than APD, even though UF is not different. APD removes more water than sodium; therefore, DSR should be measured rather than estimated from the achieved UF. The difference in DSR between the two modalities decreases in high transporters. Novel strategies proposed to increase DSR, e.g. lower sodium dialysate or adapted-APD, are promising, but ad hoc studies are necessary.

High tolerance of and removal of cefazolin sodium in single-chamber microbial fuel cells operation.

Single-chamber microbial fuel cells (MFCs) have been shown to be a promising approach for cefazolin sodium (CFZS)-contaminated wastewater treatment, in terms of electricity production, high CFZS tolerance and effective CFZS removal. MFCs exposed to CFZS loadings up to 100 mg L-1, produced stable power of 18.2 ±â€¯1.1 W m-3 and a maximum power of 30.4 ±â€¯2.1 W m-3, similar to that of CFZS-free MFCs (stable power 19.4 ±â€¯0.8 W m-3 and maximum power 32.5 ±â€¯1.6 W m-3), notwithstanding a longer acclimitisation MFC activation. More anodophilic genera (i.e. Acinetobacter, Stenotrophomonas, Lysinibacillus) and antibiotic-resisting genera (i.e. Dysgonomonas) were enriched in CFZS acclimitised anodes. Both the thickness of biofilms and the duration of CFZS acclimitisation were essential for the development of high CFZS tolerance (e.g. 450 mg L-1). The inhibition of MFCs by CFZS was reversible. The present MFCs generated a CFZS removal rate of 1.2-6.8 mg L-1 h-1 without any apparent inhibition of electricity production.

Increasing sodium removal on peritoneal dialysis: applying dialysis mechanics to the peritoneal dialysis prescription.

Optimal fluid removal on peritoneal dialysis (PD) requires removal of water coupled with sodium, which is predominantly achieved via the small pores in the peritoneal membrane. On the other hand, free-water transport takes place through aquaporin-1 channels, but leads to sodium retention and over hydration. PD prescription can be adapted to promote small pore transport to achieve improved sodium and fluid management. Both adequate dwell volume and dwell time are required for small pore transport. The dwell volume determines the amount of "wetted" peritoneal membrane being increased in the supine position and optimized at dwell volumes of approximately 1400 ml/m(2). Diffusion across the recruited small pores is time-dependent, favored by a long dwell time, and driven by the transmembrane solute gradient. According to the 3-pore model of conventional PD, sodium removal primarily occurs via convection. The clinical application of these principles is essential for optimal performance of PD and has resulted in a new approach to the automated PD prescription: adapted automated PD. In adapted automated PD, sequential short- and longer-dwell exchanges, with small and large dwell volumes, respectively, are used. A crossover trial in adults and a pilot study in children suggests that sodium and fluid removal are increased by adapted automated PD, leading to improved blood pressure control when compared with conventional PD. These findings are not explained by the current 3-pore model of peritoneal permeability and require further prospective crossover studies in adults and children for validation.

Clinoptilolite-based mixed matrix membranes for the selective recovery of potassium and ammonium.

A clinoptilolite-based mixed matrix membrane (MMM) was developed and studied for the selective recovery of ammonium and potassium. Adsorption of sodium (Na(+)), potassium (K(+)) and ammonium (NH4(+)) was investigated with single salt and equimolar salt solution under static and dynamic conditions. Furthermore, the adsorption capacity of clinoptilolite was investigated when embedded in the MMM and in clay form. Two conditioning methods were compared: HCl and NaCl. Conditioned clinoptilolite with NaCl gave higher static adsorption capacities than with HCl which alters the chemical structure of clinoptilolite. The adsorption of Na(+) was not detected in the static adsorption experiments and results showed that Na(+) adsorbed during the conditioning process it was exchanged by K(+) and NH4(+).The clinoptilolite embedded in MMM reduced the porosity of the MMM so the highest adsorption capacity was reached when the amount of polymer was the lowest: 30 wt% polymer and 70 wt% clinoptilolite. The application of MMM in a dead-end filtration cell (dynamic adsorption) resulted in higher adsorption capacities compared to static conditions and comparable results between synthetic solutions and diluted urine samples. This indicates that MMM is a suitable method for the recovery of K(+) and NH4(+) directly from a diluted urine matrix. The desorption (recovery) of K(+) and NH4(+) from MMM was higher using water at 60 °C than using an acidic treatment.