Cross-linked Polyelectrolyte and Its Function in Adsorption of Fluid and Excess Nitrogen Waste Products: an Experimental Study on Dialysate Effluent Fluid.

INTRODUCTION: One of the most important issues in patients with chronic kidney disease is fluid retention and volume overload accompanied by retention of nitrogenous waste products and some electrolytes. Bowel fluid contains high levels of urea, creatinine, uric acid, and electrolytes, which make it a potential candidate for intestinal excretion of nitrogen wastes and electrolytes. Cross-linked polyelectrolyte (CLP) is a polymer that, given orally, absorbs excess fluid, electrolyte, and nitrogenous waste products. MATERIALS AND METHODS: In an experimental study on 30 hemodialysis patients, the effect of CLP on adsorption of fluid, urea, creatinine, uric acid, sodium, and potassium were evaluated. For this purpose, 500 mL of effluent fluid of each patient were collected at the 1st hour of dialysis. The concentrations of the abovementioned products were measured by standard methods. Then the dialysate effluent samples were treated with 6 g of CLP and incubated for 4 hours at 37°C. RESULTS: Up to 80% of effluent fluid water was adsorbed by CLP. There were significant reductions in urea, creatinine, uric acid, and sodium levels in the remaining effluent fluid (P < .001). In contrast, the amount of potassium increased in the effluent fluid. CONCLUSIONS: Using CLP in addition to functional medical super adsorbents can be a possible adequate substitute for conventional dialysis methods, especially hemodialysis.

The effectiveness of systemic antibiotic therapy with and without ethanol-locked solution in the treatment of hemodialysis-related catheter infection.

Bacterial overgrowth in the inner layer of the catheter as a biofilm is highly encountered in routine medical care, and it may occur in a few days after inserting a catheter as an access in hemodialysis (HD) patients. Catheter-induced bacteremia is often due to the development of biofilms. Locking catheters with antimicrobial agents is an effective way of reducing the risk of catheter-related infection. In a controlled, randomized clinical trial, 64 chronic HD patients (32 men and 32 women with a mean age of 57.5 ± 15.6 years) were divided into case and control groups, with 32 patients in each group. The case group received systemic antibiotic and a lock of catheters with 60% ethanol and the control group received only systemic antibiotic. The results were evaluated after three weeks of treatment. The success rate of clearing infection in group A (29 patients) and group B (18 patients) was 90.6% and 56.2%, respectively (P = 0.002). We conclude that the significant difference in the success rate of clearing catheter infection in HD patients is due to the use of 60% ethanol-lock along with antibiotic therapy, and suggest this for routine use.