1
|
Cho AJ, Park HC, Kim DH, Choi HB, Song GH, Kim H, Kim SH, Choi G, Kim JK, Song YR, Yoon JW, Lee YK. Impact of needle type on substitution volume during online hemodiafiltration: plastic cannulae versus metal needles. Kidney Res Clin Pract 2023; 42:117-126. [PMID: 36328989 PMCID: PMC9902740 DOI: 10.23876/j.krcp.21.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/17/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Plastic cannulae have attracted increasing interest as an alternative to traditional metal needles with the aim of reducing cannulation-related complications. We investigated whether the substitution volumes during hemodiafiltration differ using these two types of needles in dialysis patients. METHODS An intervention study involving 26 hemodialysis patients was conducted in Korea between March and September in 2021. Patients first received online hemodiafiltration using traditional metal needles, and thereafter plastic cannulae were used in a stepwise protocol. Repeated-measures design and linear mixed-effect models were used to compare substitution volumes between the two needle types with the same inner diameter. RESULTS The mean patient age was 62.7 years, and their mean dialysis vintage was 95.2 months. Most patients (92.3%) had an arteriovenous fistula as the vascular access. The substitution volume increased as blood flow and needle size increased for both plastic cannulae and metal needles. The substitution volume was significantly higher with 17-gauge (G) plastic cannulae than with 16-G metal needles at blood flow rates of 280, 300, and 330 mL/min. Similar results were obtained for 15-G metal needles and 16-G plastic cannulae at a blood flow rate of 330 mL/min. However, the patient ratings of pain on a visual analogue scale were higher for plastic cannulae. CONCLUSION Higher substitution volumes were obtained at the same prescribed blood flow rate with plastic cannulae than with metal needles during online hemodiafiltration. Plastic cannulae are an option for achieving high-volume hemodiafiltration for patients with low blood flow rates.
Collapse
Affiliation(s)
- AJin Cho
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Han Byul Choi
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Gi Hyun Song
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Seok-hyung Kim
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Gwangho Choi
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Jwa-Kyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea,Jong-Woo Yoon Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Republic of Korea. E-mail:
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea,Correspondence: Young-Ki Lee Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. E-mail:
| |
Collapse
|
2
|
Schiffl H. Online hemodiafiltration and mortality risk in end-stage renal disease patients: A critical appraisal of current evidence. Kidney Res Clin Pract 2019; 38:159-168. [PMID: 31137926 PMCID: PMC6577208 DOI: 10.23876/j.krcp.18.0160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/24/2019] [Accepted: 03/10/2019] [Indexed: 12/15/2022] Open
Abstract
The life expectancy of end-stage renal disease patients undergoing regular hemodialysis (HD) remains significantly lower than in the general population. Reducing excess mortality by improving renal replacement options is an unmet medical need. Online post-dilution hemodiafiltration (HDF) has been promoted as the gold standard, offering improved clinical outcomes, based on numerous observational studies that suggest a reduced mortality risk and lower morbidity with HDF compared with standard HD. However, most randomized controlled trials (RCTs) have failed to demonstrate a significant beneficial effect of HDF on all-cause mortality. The effects on secondary outcomes were often negligible or absent. Unfortunately, these RCTs were characterized by a moderate to high risk of bias. In post-hoc analyses of the largest RCTs and meta-analysis of individual participant data from four RCTs, HDF patients receiving the highest convection volume consistently and dose-dependently saw superior outcomes. However, as these studies were not designed a priori to clarify this issue, and there are no indisputable mechanisms underlying reduced mortality risks, we cannot exclude the possibility that the health status of patients (with vascular access as a proxy) may affect outcomes more than the convective technique itself. There is currently insufficient evidence to support the contention that high-volume HDF confers relevant benefits to patients over standard HD. The conflicting data of published RCTs reduce confidence in the superiority of high-volume convective therapy. Hopefully, ongoing large RCTs (for example, CONVINCE) may supply an indisputable answer to the crucial question of high-volume HDF.
Collapse
Affiliation(s)
- Helmut Schiffl
- Department of Internal Medicine IV, Medical Center of the University of Munich, Munich, Germany
| |
Collapse
|
3
|
De La Mata NL, Alfaro-Ramirez M, Kelly PJ, Masson P, Al-Shahi Salman R, Webster AC. Absolute risk and risk factors for stroke mortality in patients with end-stage kidney disease (ESKD): population-based cohort study using data linkage. BMJ Open 2019; 9:e026263. [PMID: 30798318 PMCID: PMC6398758 DOI: 10.1136/bmjopen-2018-026263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION People with end-stage kidney disease (ESKD) have up to 30-fold higher risk of stroke than the general population. OBJECTIVE To determine risk factors associated with stroke death in the ESKD population. METHODS We identified all patients with incident ESKD in Australia (1980-2013) and New Zealand (1988-2012) from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) registry. We ascertained underlying cause of death from data linkage with national death registries and risk factors from ANZDATA. Using a competing risks multivariable regression model, we estimated cumulative incidence of stroke and non-stroke deaths, and risk factors for stroke deaths (adjusted sub-HR, SHR). RESULTS We included 60 823 people with ESKD. There were 941 stroke deaths and 33 377 non-stroke deaths during 381 874 person-years of follow-up. Overall, the cumulative incidence of stroke death was 0.9% and non-stroke death was 36.8% 5 years after starting ESKD treatment. The risk of stroke death was higher at older ages (SHR 1.92, 95% CI 1.45 to 2.55), in females (SHR 1.41, 95% CI 1.21 to 1.64), in people with cerebrovascular disease (SHR 2.39, 95% CI 1.99 to 2.87), with ESKD caused by hypertensive/renovascular disease (SHR 1.39, 95% CI 1.09 to 1.78) or polycystic kidney disease (SHR 1.38, 95% CI 1.00 to 1.90), with earlier year of ESKD treatment initiation (SHR 1.93, 95% CI 1.56 to 2.39) and receiving dialysis (transplant vs haemodialysis SHR 0.27, 95% CI 0.09 to 0.84). CONCLUSION Patients with ESKD with higher risk of stroke death are older, women, with cerebrovascular disease, with hypertensive/renovascular or polycystic kidney disease cause of ESKD, with earlier year of ESKD treatment and receiving dialysis. These groups may benefit from targeted stroke prevention interventions.
Collapse
Affiliation(s)
| | - Maria Alfaro-Ramirez
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Philip Masson
- Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Angela C Webster
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Becs G, Hudák R, Fejes Z, Debreceni IB, Bhattoa HP, Balla J, Kappelmayer J. Haemodiafiltration elicits less platelet activation compared to haemodialysis. BMC Nephrol 2016; 17:147. [PMID: 27737645 PMCID: PMC5064778 DOI: 10.1186/s12882-016-0364-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/11/2016] [Indexed: 11/20/2022] Open
Abstract
Background Mortality in patients with end-stage renal disorders is often a consequence of cardiovascular complications. Renal replacement therapies may contribute to this morbidity by promoting cellular activation. In renal failure patients peripheral blood samples were investigated for platelet and endothelial cell activation markers to compare the effects of haemodiafiltration (HDF) and haemodialysis (HD). Methods Overall 28 patients were included in the study. Platelet P-selectin and leukocyte - platelet heterotypic aggregates were studied by flow cytometry. Soluble P- and E-selectin values were determined by ELISA, while von Willebrand factor (vWF) antigen levels were measured by immunoturbidimetry. Statistical analysis was done by the SPSS v22 software. Results Platelet surface P-selectin was below 3.0 % in healthy controls, but it was higher during the dialysis after 4 h, 8 % and 14.3 % in HDF and HD, respectively. Monocyte-platelet heterotypic aggregates were significantly elevated after 4 h in both treatments, up to 69.2 % in HDF and to 82.9 % in HD. Soluble P-selectin levels were also significantly elevated by the end of both treatment procedures (p < 0.001), vWF antigen values, however, showed elevation only during HD treatment. Conclusions The attenuated platelet activating effects of HDF compared to HD may contribute to a less unfavourable vascular effect in this treatment modality. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0364-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gergely Becs
- Department of Nephrology, University of Debrecen, Debrecen, Hungary
| | - Renáta Hudák
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, Hungary
| | - Zsolt Fejes
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, Hungary
| | - Ildikó Beke Debreceni
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, Hungary
| | - Harjit Pal Bhattoa
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, Hungary
| | - József Balla
- Department of Nephrology, University of Debrecen, Debrecen, Hungary.,MTA-DE Vascular Biology, Thrombosis and Hemostasis Research Group, Hungarian Academy of Sciences, Debrecen, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, Hungary.
| |
Collapse
|
5
|
Kaleekkal NJ, Rana D, Mohan D. Functionalized MWCNTs in improving the performance and biocompatibility of potential hemodialysis membranes. RSC Adv 2016. [DOI: 10.1039/c6ra09354j] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Functionalized multi-walled carbon nanotube incorporated polyetherimide mixed matrix membranes for blood purification application.
Collapse
Affiliation(s)
- Noel Jacob Kaleekkal
- Membrane Laboratory
- Department of Chemical Engineering
- Anna University
- Chennai-600025
- India
| | - Dipak Rana
- Department of Chemical and Biological Engineering
- University of Ottawa
- Ottawa
- Canada
| | - D. Mohan
- Membrane Laboratory
- Department of Chemical Engineering
- Anna University
- Chennai-600025
- India
| |
Collapse
|
6
|
Repopulation of porcine kidney scaffold using porcine primary renal cells. Acta Biomater 2016; 29:52-61. [PMID: 26596567 DOI: 10.1016/j.actbio.2015.11.026] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 12/23/2022]
Abstract
The only definitive treatment for end stage renal disease is renal transplantation, however the current shortage of organ donors has resulted in a long list of patients awaiting transplant. Whole organ engineering based on decellularization/recellularization techniques has provided the possibility of creating engineered kidney constructs as an alternative to donor organ transplantation. Previous studies have demonstrated that small units of engineered kidney are able to maintain function in vivo. However, an engineered kidney with sufficient functional capacity to replace normal renal function has not yet been developed. One obstacle in the generation of such an organ is the development of effective cell seeding methods for robust colonization of engineered kidney scaffolds. We have developed cell culture methods that allow primary porcine renal cells to be efficiently expanded while maintaining normal renal phenotype. We have also established an effective cell seeding method for the repopulation of acellular porcine renal scaffolds. Histological and immunohistochemical analyses demonstrate that a majority of the expanded cells are proximal tubular cells, and the seeded cells formed tubule-like structures that express normal renal tubule phenotypic markers. Functional analysis revealed that cells within the kidney construct demonstrated normal renal functions such as re-adsorption of sodium and protein, hydrolase activity, and production of erythropoietin. These structural and functional outcomes suggest that engineered kidney scaffolds may offer an alternative to donor organ transplant. STATEMENT OF SIGNIFICANCE Kidney transplantation is the only definitive treatment for end stage renal disease, however the current shortage of organ donors has limited the treatment. Whole organ engineering based on decellularization/recellularization techniques has provided the possibility of creating engineered kidney constructs as an alternative to donor organ transplantation. While previous studies have shown that small units of engineered kidneys are able to maintain function in animal studies, engineering of kidneys with sufficient functional capacity to replace normal renal function is still challenging due to inefficient cell seeding methods. This study aims to establish an effective cell seeding method using pig kidney cells for the repopulation of acellular porcine kidney scaffolds, suggesting that engineered kidneys may offer an alternative to donor organ transplant.
Collapse
|
7
|
Amado L, Ferreira N, Miranda V, Meireles P, Povera V, Ferreira R, Fazendeiro-Matos J, Teixeira L, Paúl C, Santos-Silva A, Costa E. SELF-REPORTED MEDICATION ADHERENCE IN PATIENTS WITH END-STAGE KIDNEY DISEASE UNDERGOING ONLINE-HAEMODIAFILTRATION. J Ren Care 2015; 41:231-8. [PMID: 26768798 DOI: 10.1111/jorc.12127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Non-adherence to therapeutic regimens is a recognised problem in the dialysis population that compromises the opportunity to achieve maximum treatment effect and, therefore, might lead to increased morbidity and mortality. In this study, we aimed to evaluate the prevalence of self-reported medication non-adherence in patients with end-stage kidney disease (ESKD) undergoing online-haemodiafiltration (OL-HDF), as well as to evaluate the factors that could affect medication adherence. PATIENTS AND METHODS We evaluated 122 patients with ESKD undergoing OL-HDF. Patients' reported medication adherence was measured by the Measure Treatment Adherence (MTS) scale. Social support was evaluated by the abbreviated Lubben Social Network Scale (LSNS); depression status by the Geriatric Depression Scale (GDS). Socio-demographic, co-morbidity and clinical data were also evaluated. RESULTS Our results showed that 10.7% of patients with ESKD perceived themselves as non-adherent to medication. When two groups of patients (adherent and non-adherents) were compared, significantly higher levels of triglycerides, and higher diastolic and systolic blood pressure were found in the non-adherent group. Significant correlations were found between the MTS score, and diastolic blood pressure, age and GDS score. Multiple regression analysis identified age and the GDS score as independent variables significantly associated with the MTS score. CONCLUSIONS Non-adherence to therapeutic regimens in patients with ESKD is associated with higher levels of triglycerides and higher blood pressure and are, therefore, at a higher cardiovascular risk. Moreover, we found that age and depression status are important variables in non-adherence to therapeutic regimens.
Collapse
Affiliation(s)
| | - Nuno Ferreira
- Nephrocare Portugal, SA-Nephrocare Maia, Maia, Portugal
| | - Vasco Miranda
- Nephrocare Portugal, SA-Nephrocare Maia, Maia, Portugal
| | - Patricia Meireles
- Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal.,Dr. Francisco Zagalo Hospital, Ovar, Portugal
| | - Verónica Povera
- UNIFAI, Unit of Research and Training in Adults and Elderly, University of Porto, Porto, Portugal
| | - Ricardo Ferreira
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | | | - Laetitia Teixeira
- Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal.,UNIFAI, Unit of Research and Training in Adults and Elderly, University of Porto, Porto, Portugal
| | - Constança Paúl
- Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal.,UNIFAI, Unit of Research and Training in Adults and Elderly, University of Porto, Porto, Portugal
| | - Alice Santos-Silva
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.,UCIBIO@REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Elísio Costa
- Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.,UCIBIO@REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal
| |
Collapse
|
8
|
Moura A, Madureira J, Alija P, Fernandes JC, Oliveira JG, Lopez M, Filgueiras M, Amado L, Sameiro-Faria M, Miranda V, Santos-Silva A, Costa E. Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-Hemodiafiltration. Aging Dis 2015; 6:17-26. [PMID: 25657849 DOI: 10.14336/ad.2014.0514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/01/2022] Open
Abstract
This work aimed to evaluate how aging could influence patients' perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient's records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management.
Collapse
Affiliation(s)
- Alexandra Moura
- Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Porto, Portugal
| | | | - Pablo Alija
- Clínica de Hemodiálise NefroServe, Barcelos, Portugal
| | | | | | - Martin Lopez
- Clínica de Hemodiálise de Felgueira, Felgueiras, Portugal
| | | | | | | | | | - Alice Santos-Silva
- Laboratório de Bioquímica, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Portugal ; Instituto de Biologia Molecular e Celular, Universidade do Porto, Portugal
| | - Elísio Costa
- Laboratório de Bioquímica, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto, Portugal ; Instituto de Biologia Molecular e Celular, Universidade do Porto, Portugal
| |
Collapse
|
9
|
Ferraz N, Mihranyan A. Is there a future for electrochemically assisted hemodialysis? Focus on the application of polypyrrole–nanocellulose composites. Nanomedicine (Lond) 2014; 9:1095-110. [DOI: 10.2217/nnm.14.49] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This work summarizes the various aspects of using electrochemically assisted solute removal techniques in hemodialysis with a focus on blood electrodialysis and electrochemically controlled uremic retention solute removal using polypyrrole. In particular, the feasibility of using highly porous conductive polypyrrole–Cladophora cellulose membranes for hemodialysis are overviewed as a part of our dedicated research efforts during the past 4 years. The potential benefits and the current limitations associated with using the electrochemically controlled uremic retention solute removal techniques are discussed in detail.
Collapse
Affiliation(s)
- Natalia Ferraz
- Nanotechnology & Functional Materials, Department of Engineering Sciences, Box 534, Uppsala University, 75121 Uppsala, Sweden
| | - Albert Mihranyan
- Nanotechnology & Functional Materials, Department of Engineering Sciences, Box 534, Uppsala University, 75121 Uppsala, Sweden
- Division of Materials Science, Luleå University of Technology, 97187 Luleå, Sweden
| |
Collapse
|
10
|
Barta K, Czifra Á, Kun C, Páll A, Kulcsár J, Paragh G, Lőrincz I, Padra TJ, Agarwal A, Zarjou A, Abolfazl Z, Balla J, Szabó Z. Hemodiafiltration beneficially affects QT interval duration and dispersion compared to hemodialysis. Clin Exp Nephrol 2014; 18:952-9. [PMID: 24590361 DOI: 10.1007/s10157-014-0950-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/14/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The prolongation of the QT interval and dispersion could predict ventricular arrhythmias. It is not yet established whether there is a difference between the effects of hemodialysis and hemodiafiltration on QT interval duration and dispersion. METHODS Data of thirty patients was investigated while they were receiving hemodiafiltration over a period of 3 months; then the same group of patients was evaluated during treatment with conventional hemodialysis for at least another 3 months. Ionic parameters and surface electrocardiograms (ECG) were analyzed five times during each session, and 2D, M-mode echocardiography and Holter ECGs were performed to acquire additional information. RESULTS QT interval duration (QTmax) and dispersion (QTd) showed a significant increase during hemodialysis, but not during hemodiafiltration. QTmax was 388.66 ± 31.81 ms at the beginning of hemodialysis and increased to 400.66 ± 39.12 ms even at the 30th minute (p < 0.05). QTd was found to be 31.33 ± 10.08 ms before the commencement of hemodialysis with the largest prolongation being seen at the 240th minute (51.33 ± 14.56 ms, p < 0.05). The occurrence of ventricular premature beats was significantly higher during hemodialysis (p = 0.018). The left atrial diameter significantly decreased at the end of hemodiafiltration (at the beginning 45.1 ± 5.25 mm, at the end 40.77 ± 5.76 mm; p < 0.05). CONCLUSION Our results suggest a beneficial effect of hemodiafiltration on the studied electrocardiographic parameters compared to hemodialysis. The larger decrease in the left atrial diameter suggests a more efficient intracardiac volume-decreasing potential of hemodiafiltration.
Collapse
Affiliation(s)
- Kitti Barta
- Division of Nephrology, Department of Medicine, Medical and Health Science Centre, University of Debrecen, Pf. 19. Nagyerdei Krt. 98, Debrecen, 4012, Hungary
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Bowry SK, Canaud B. Achieving high convective volumes in on-line hemodiafiltration. Blood Purif 2013; 35 Suppl 1:23-8. [PMID: 23466374 DOI: 10.1159/000346379] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
On-line hemodiafiltration (OL-HDF) has established itself as a highly efficient and safe form of renal replacement therapy, providing clinical benefits for several conditions that afflict end-stage chronic kidney disease patients. Additionally, evidence now ascribes a survival benefit to OL-HDF. The first indication that mortality rates decline with high-efficiency OL-HDF was provided by the European results from the DOPPS. Since then, the RISCAVID, CONTRAST and the Turkish HDF trials have all substantiated the original findings that higher convection volumes are favorable in terms of improved survival. With the emerging concept of convection volume impacting patient survival, we examine the factors and practical approaches by which maximal convection volumes can actually be achieved and individualized for each patient treated with OL-HDF. We believe that with these factors in mind, all attempts should be made to maximize convective volume, and hence the convective dose, to enable the patient to derive the full benefits of OL-HDF over extended periods.
Collapse
Affiliation(s)
- Sudhir K Bowry
- Medical Board EMEALA, Fresenius Medical Care, Bad Homburg, Germany.
| | | |
Collapse
|
12
|
Leurs P, Lindholm B, Stenvinkel P. Effects of Hemodiafiltration on Uremic Inflammation. Blood Purif 2013; 35 Suppl 1:11-7. [DOI: 10.1159/000346359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
13
|
Schiffl H, Lang SM, Fischer R. Effects of high efficiency post-dilution on-line hemodiafiltration or conventional hemodialysis on residual renal function and left ventricular hypertrophy. Int Urol Nephrol 2012; 45:1389-96. [PMID: 23225079 DOI: 10.1007/s11255-012-0336-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Residual renal function (RRF) contributes to dialysis adequacy, quality of life and survival of hemodialysis patients. There is an ongoing debate whether better preservation of residual renal function is the result of chronic fluid volume overload. Our prospective investigation analyzed the effects of different dialytic therapies on RRF and left ventricular hypertrophy, which may be considered--at least in part--a surrogate marker of chronic fluid overload. METHODS Two cohorts of end-stage renal disease patients initiating renal replacement therapy (high efficiency post-dilution on-line hemodiafiltration (HDF) in 58 patients, conventional hemodialysis (HD) in 60 patients) were prospectively followed up. RRF was determined at baseline, 12 and 24 months, left ventricular mass index (LVMI) at baseline and after 24 months. RESULTS Demographic and renal characteristics, medication or exposure to nephrotoxins were comparable among the two cohorts of patients. RRF declined in all patients throughout the 2-year study period. In HDF patients, the decline was less pronounced (28 %) than in conventional HD patients (68 %). More patients undergoing HD received cardio- and renoprotective antihypertensive drugs. CRP levels were significantly higher in conventional HD. Hypotensive episodes were fewer in HDF. LVMI decreased in 90 % of HDF compared to only 25 %of HD patients. CONCLUSIONS Our data clearly indicate that better preservation of RRF by high efficiency hemodiafiltration is not associated with left ventricular hypertrophy.
Collapse
Affiliation(s)
- Helmut Schiffl
- KfH Nierenzentrum München-Laim, Elsenheimerstr. 63, 80687, Munich, Germany,
| | | | | |
Collapse
|
14
|
Variation of clinical and laboratory features in chronic dialysis patients treated with high-flux hemodialysis after switching to online hemodiafiltration. Int Urol Nephrol 2012; 45:1415-22. [PMID: 23212146 DOI: 10.1007/s11255-012-0341-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The study of online hemodiafiltration (HDF) benefits over high-flux hemodialysis (HD) raises great interest. The purpose was to compare clinical and laboratory parameters in patients treated with HD who were switched to HDF. METHODS Forty-eight HD patients (study group) were switched to HDF, while other 521 patients remained on HD as a control group. During last 6 HD months and during first year of HDF, we determined in both groups the following parameters: monthly-weekly dialysis time, systolic and diastolic blood pressure, body mass index (BMI), interdialytic body weight gain (IBWG), blood flow rate (Qb), weekly erythropoietin-stimulating agents dose (EPO), single-pool Kt/V, calcium, phosphorus (P), hemoglobin and normalized protein catabolic ration (nPCR), plus every 3 months--albumin, parathormone (PTH), ferritin and transferrin saturation (TSAT). In both groups, parameters in the last 6 HD months were compared to those in the first 6 months and, respectively, to those in the first year of HDF. RESULTS In the study group, albumin and nPCR were significantly higher in the HD period not only compared to the first 6 months of HDF, but also compared to the first year of HDF. IBWG and P were higher with HD compared to the first year of HDF, but not with the first 6 months. PTH, Kt/V, Qb and EPO were higher in both HDF periods. In the control group, albumin was significantly higher in the first 6 months after the switch, but it was significantly lower in the first year. BMI, ferritin, PTH, Kt/V, Qb, TSAT and weekly dialysis time were higher in both HDF periods, while nPCR, EPO, SBP and DBP were lower. IBWG and Hb rose only during the first year after the switch, while P was lower in the first year, but not in the first 6 months. CONCLUSIONS Nutrition, assessed by albumin, nPCR and BMI, was not improved by HDF compared to HD. With HDF, Kt/V and phosphorus control were better, similar results were observed in the control group. A larger EPO dose was needed with HDF for maintaining a similar hemoglobin level.
Collapse
|