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Namagondlu Seetharamaiah G, Marisiddappa L, Dhareshwar S, Rani S, Das N. Application of therapeutic ultrasonic waves across the dialyzer membrane: A pilot study on the impact on dialyzer clearance and safety. Hemodial Int 2024. [PMID: 38783838 DOI: 10.1111/hdi.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/27/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Progressive clogging of the dialyzer membrane during hemodialysis can compromise solute removal efficiency. Existing solutions fall short in addressing intradialytic reduction of dialyzer clearance. This pilot study aims to assess the impact and safety of applying therapeutic ultrasonic waves to dialyzers for mitigating intradialytic clogging. METHODS In this pilot study, 15 stable maintenance hemodialysis patients (12 males and 3 females) were enrolled. Each patient served as their own control. They underwent one session of hemodialysis with the application of therapeutic ultrasonic waves (Ultrasonic session) and were crossed-over to a second session without the use of ultrasonic waves (Control session). All the study sessions operated at a fixed dialysate flow rate of 500 mL/min and a blood flow rate of 250 or 300 mL/min. The adequacy of dialysis achieved during each session was monitored using Online Clearance Monitoring of the dialysis machines, and clearance K values, varying between 135 and 209 mL/min, were recorded, and plotted. A direct comparison between Control and Ultrasonic sessions was performed to assess the impact and safety of using ultrasonic waves during hemodialysis. FINDINGS The mean percentage decline in dialyzer clearance values was 4.41% for Ultrasonic sessions (SD: 5.3) and 12.69% for Control sessions (SD: 6.35) (p-value <0.001). This indicates that the application of ultrasonic waves reduced the decline in clearance values. The mean differences of the blood component parameters were comparable between both Ultrasonic sessions and Control sessions, suggesting the safety of utilizing ultrasonic waves during dialysis. Microscopic membrane analysis corroborated the safety. DISCUSSION Intradialytic clogging of dialyzer membranes is a significant problem that can cause dialysis inadequacy. Our study tackles this issue by introducing therapeutic ultrasonic waves to improve dialyzer clearance during hemodialysis sessions in patients.
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Affiliation(s)
| | | | | | | | - Nikhil Das
- Sedign Solutions Pvt. Ltd., Bengaluru, India
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Sinha R, Rocco MV, Daeihagh P, Staples AE. Innovating dialysis through computational modelling of hollow-fibre haemodialysers. Nat Rev Nephrol 2024; 20:269-270. [PMID: 38438536 DOI: 10.1038/s41581-024-00826-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Ruhit Sinha
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
| | - Michael V Rocco
- Section of Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Pirouz Daeihagh
- Section of Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anne E Staples
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
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Ramírez-Guerrero G, Reis T, Marcello M, de Cal M, Ronco C. Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options? Int J Artif Organs 2024; 47:3-7. [PMID: 37589299 DOI: 10.1177/03913988231191954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Valparaiso Region, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Valparaiso Region, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Valparaiso Region, Chile
| | - Thiago Reis
- Deparment of Nephrology and Kidney Transplantation, Fenix Group, Sao Paulo, Brazil
- Laboratory of Molecular Pharmacology, University of Brasília, Brasília, Brazil
| | - Matteo Marcello
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
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Lin W, Mousavi F, Blum BC, Heckendorf CF, Moore J, Lampl N, McComb M, Kotelnikov S, Yin W, Rabhi N, Layne MD, Kozakov D, Chitalia VC, Emili A. Integrated metabolomics and proteomics reveal biomarkers associated with hemodialysis in end-stage kidney disease. Front Pharmacol 2023; 14:1243505. [PMID: 38089059 PMCID: PMC10715419 DOI: 10.3389/fphar.2023.1243505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/13/2023] [Indexed: 02/25/2024] Open
Abstract
Background: We hypothesize that the poor survival outcomes of end-stage kidney disease (ESKD) patients undergoing hemodialysis are associated with a low filtering efficiency and selectivity. The current gold standard criteria using single or several markers show an inability to predict or disclose the treatment effect and disease progression accurately. Methods: We performed an integrated mass spectrometry-based metabolomic and proteomic workflow capable of detecting and quantifying circulating small molecules and proteins in the serum of ESKD patients. Markers linked to cardiovascular disease (CVD) were validated on human induced pluripotent stem cell (iPSC)-derived cardiomyocytes. Results: We identified dozens of elevated molecules in the serum of patients compared with healthy controls. Surprisingly, many metabolites, including lipids, remained at an elevated blood concentration despite dialysis. These molecules and their associated physical interaction networks are correlated with clinical complications in chronic kidney disease. This study confirmed two uremic toxins associated with CVD, a major risk for patients with ESKD. Conclusion: The retained molecules and metabolite-protein interaction network address a knowledge gap of candidate uremic toxins associated with clinical complications in patients undergoing dialysis, providing mechanistic insights and potential drug discovery strategies for ESKD.
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Affiliation(s)
- Weiwei Lin
- Center for Network Systems Biology, Boston University, Boston, MA, United States
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
| | - Fatemeh Mousavi
- Center for Network Systems Biology, Boston University, Boston, MA, United States
| | - Benjamin C. Blum
- Center for Network Systems Biology, Boston University, Boston, MA, United States
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
| | - Christian F. Heckendorf
- Center for Network Systems Biology, Boston University, Boston, MA, United States
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
| | - Jarrod Moore
- Center for Network Systems Biology, Boston University, Boston, MA, United States
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
| | - Noah Lampl
- Center for Network Systems Biology, Boston University, Boston, MA, United States
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
| | - Mark McComb
- Center for Network Systems Biology, Boston University, Boston, MA, United States
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
| | - Sergei Kotelnikov
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, United States
| | - Wenqing Yin
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Nabil Rabhi
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
| | - Matthew D. Layne
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
| | - Dima Kozakov
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, United States
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Institute of Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Andrew Emili
- Center for Network Systems Biology, Boston University, Boston, MA, United States
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, United States
- Department of Biology, Boston University, Boston, MA, United States
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Reis T, Ronco C, Soranno DE, Clark W, De Rosa S, Forni LG, Lorenzin A, Ricci Z, Villa G, Kellum JA, Mehta R, Rosner MH. Standardization of Nomenclature for the Mechanisms and Materials Utilized for Extracorporeal Blood Purification. Blood Purif 2023; 53:329-342. [PMID: 37703868 DOI: 10.1159/000533330] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/28/2023] [Indexed: 09/15/2023]
Abstract
In order to develop a standardized nomenclature for the mechanisms and materials utilized during extracorporeal blood purification, a consensus expert conference was convened in November 2022. Standardized nomenclature serves as a common language for reporting research findings, new device development, and education. It is also critically important to support patient safety, allow comparisons between techniques, materials, and devices, and be essential for defining and naming innovative technologies and classifying devices for regulatory approval. The multidisciplinary conference developed detailed descriptions of the performance characteristics of devices (membranes, filters, and sorbents), solute and fluid transport mechanisms, flow parameters, and methods of treatment evaluation. In addition, nomenclature for adsorptive blood purification techniques was proposed. This report summarizes these activities and highlights the need for standardization of nomenclature in the future to harmonize research, education, and innovation in extracorporeal blood purification therapies.
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Affiliation(s)
- Thiago Reis
- Department of Nephrology and Kidney Transplantation, Fenix Group, São Paulo, Brazil
- Laboratory of Molecular Pharmacology, University of Brasília, Brasília, Brazil
- Division of Nephrology, Syrian-Lebanese Hospital, São Paulo, Brazil
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
- Department of Medicine (DIMED), Università degli Studi di Padova, Padua, Italy
| | - Danielle E Soranno
- Section of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William Clark
- Davidson School of Chemical Engineering, Purdue University College of Engineering, West Lafayette, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Silvia De Rosa
- Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital Foundation Trust, Guildford, UK
- Faculty of Health Sciences, University of Surrey, Guildford, UK
| | - Anna Lorenzin
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Zaccaria Ricci
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
- Pediatric Intensive Care Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Section of Pain Therapy and Palliative Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ravindra Mehta
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health, Charlottesville, Virginia, USA
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Meijers B, Vega A, Juillard L, Kawanishi H, Kirsch AH, Maduell F, Massy ZA, Mitra S, Vanholder R, Ronco C, Cozzolino M. Extracorporeal Techniques in Kidney Failure. Blood Purif 2023; 53:343-357. [PMID: 38109873 DOI: 10.1159/000533258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/20/2023] [Indexed: 12/20/2023]
Abstract
During the last decades, various strategies have been optimized to enhance clearance of a variable spectrum of retained molecules to ensure hemodynamic tolerance to fluid removal and improve long-term survival in patients affected by kidney failure. Treatment effects are the result of the interaction of individual patient characteristics with device characteristics and treatment prescription. Historically, the nephrology community aimed to provide adequate treatment, along with the best possible quality of life and outcomes. In this article, we analyzed blood purification techniques that have been developed with their different characteristics.
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Affiliation(s)
- Bjorn Meijers
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Nephrology, UZ Leuven, Leuven, Belgium
| | - Almudena Vega
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Laurent Juillard
- Medical School, Claude Bernard University (Lyon 1), Villeurbanne, France
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hideki Kawanishi
- Department of Kidney Diseases and Blood Purification Therapy, Tsuchiya General Hospital, Hiroshima, Japan
| | | | - Francisco Maduell
- Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ziad A Massy
- Service de Néphrologie, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris et Université Paris-Saclay (Versailles-Saint-Quentin-en-Yvelines), Boulogne Billancourt, France
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Villejuif, France
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, Manchester University Hospitals, Manchester, UK
| | - Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, University Hospital, Ghent, Belgium
- European Kidney Health Alliance, Brussels, Belgium
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, Milan, Italy
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Meyer TW, Lee S, Whitmer LC, Blanco IJ, Suba JK, Sirich TL. Increasing the Clearance of Protein-Bound Solutes by Recirculating Dialysate through Activated Carbon. KIDNEY360 2023; 4:e744-e750. [PMID: 37211642 PMCID: PMC10371360 DOI: 10.34067/kid.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/05/2023] [Indexed: 05/23/2023]
Abstract
Key Points Conventional hemodialysis provides limited clearance of uremic solutes that bind to plasma proteins. No studies have yet tested whether increasing the clearance of bound solutes provides clinical benefit. Practical means to increase the dialytic clearance of bound solutes are required to perform such studies. Background Conventional hemodialysis provides limited clearance of uremic solutes that bind to plasma proteins. However, no studies have tested whether increasing the clearance of bound solutes provides clinical benefit. Practical means to increase the dialytic clearance of bound solutes are required to perform such studies. Methods Artificial plasma was dialyzed using two dialysis systems in series. In the first recirculating system, a fixed small volume of dialysate flowed rapidly through an activated carbon block before passing through two large dialyzers. In a second conventional system, a lower flow of fresh dialysate was passed through a single dialyzer. Chemical measurements tested the ability of the recirculating system to increase the clearance of selected solutes. Mathematical modeling predicted the dependence of solute clearances on the extent to which solutes were taken up by the carbon block and were bound to plasma proteins. Results By itself, the conventional system provided clearances of the tightly bound solutes p-cresol sulfate and indoxyl sulfate of only 18±10 and 19±11 ml/min, respectively (mean±SD). Because these solutes were effectively adsorbed by the carbon block, the recirculating system by itself provided p-cresol sulfate and indoxyl sulfate clearances of 45±11 and 53±16 ml/min. It further raised their clearances to 54±12 and 61±17 ml/min when operating in series with the conventional system (P < 0.002 versus conventional clearance both solutes). Modeling predicted that the recirculating system would increase the clearances of bound solute even if their uptake by the carbon block was incomplete. Conclusions When added to a conventional dialysis system, a recirculating system using a carbon block sorbent, a single pump, and standard dialyzers can greatly increase the clearance of protein-bound uremic solutes.
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Affiliation(s)
- Timothy W. Meyer
- The Department of Medicine, Stanford University, Palo Alto, California
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California
| | - Seolhyun Lee
- The Department of Medicine, Stanford University, Palo Alto, California
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California
| | - Luke C. Whitmer
- The Department of Medicine, Stanford University, Palo Alto, California
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California
| | - Ignacio J. Blanco
- The Department of Medicine, Stanford University, Palo Alto, California
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California
| | - Josef K. Suba
- The Department of Medicine, Stanford University, Palo Alto, California
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California
| | - Tammy L. Sirich
- The Department of Medicine, Stanford University, Palo Alto, California
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California
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Diffusive solute transport in hollow fiber dialyzers is not affected by variable feed viscosity. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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