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1.
Medicine (Baltimore) ; 99(21): e20447, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481347

RESUMO

Different measures of rates of transfer of glucose during the peritoneal equilibrium test (PET), undertaken during peritoneal dialysis (PD) might provide additional information regarding a patient's risk of future cardiovascular mortality. This study aimed to characterize the heterogeneity of dialysate glucose (DG) response phenotypes during the PET and compare the cardiovascular mortality rates associated with the different phenotypes. Our cohort was derived from Henan peritoneal dialysis registry. A total of 3477 patients initiating PD in 2007 to 2014 had the DG measured at 0, 2-hour and 4-hour (D0, D2, and D4 respectively) during the PET for estimation of D2/D0 and D4/D0. Deaths mainly due to CVD within 2 years since the initiation of PD were defined as the outcome. Latent class mixed-effect models were fitted to identify distinct phenotypes of the DG response during the PET. Multivariable unconditional Logistic regression models with adjustment for cardiometabolic risk factors were used to compare the 2-year risk of cardiovascular mortality among patients in the different latent classes. Three distinct DG response phenotypes during the PET were identified. Those with consistently high D2/D0 and D4/D0 ratios had a 1.22 [95% confidence interval: 1.02, 1.35] excess risk of a cardiovascular death within 2 years of commencing PD compared with patients with the lowest D2/D0 ratio and decreased D4/D0 ratio after adjustment for cardiometabolic risk factors. Consistently elevated D2/D0 and D4/D0 ratios during the PET are associated with an increased risk of 2-year cardiovascular mortality independent of other cardiometabolic risk factors. In view of the potential bias due to unmeasured confounders (eg, Family history of cardiovascular diseases, and dietary patterns), this association should be further validated in other external cohorts.


Assuntos
Doenças Cardiovasculares/mortalidade , Soluções para Diálise/efeitos adversos , Glucose/metabolismo , Diálise Peritoneal/mortalidade , Adulto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Estudos de Coortes , Soluções para Diálise/uso terapêutico , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/métodos , Peritônio/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Fatores de Tempo
2.
G Ital Nefrol ; 37(2)2020 Apr 09.
Artigo em Italiano | MEDLINE | ID: mdl-32281763

RESUMO

In recent years imaging techniques that use radionuclides have become more and more clinically relevant as they can provide functional information for specific anatomical districts. This has also involved nephrology, where radionuclides are used to study patients with different degrees of renal function failure up to terminal uremia. Although chronic kidney disease, and dialysis in particular, may affect the distribution and the elimination of radiopharmaceuticals, to date there are no consistent data on the risks associated with their use in this clinical context. In addition to the lack of data on the safety of radio-exposure in dialysis patients, there is also a shortage of information concerning the risk for healthcare staff involved in conducting the dialysis sessions performed after a nuclear test. This study, performed on 29 uremic patients who underwent hemodialysis immediately after a scintigraphic examination, assessed the extent of radio-contamination of the staff and of hemodialysis devices such as monitor, kits and dialysate. The data collected has been used to quantify the radiological risk in dialysis after the exposure to the most common radionuclides.


Assuntos
Falência Renal Crônica/diagnóstico por imagem , Compostos Radiofarmacêuticos/metabolismo , Diálise Renal , Soluções para Diálise/química , Soluções para Diálise/metabolismo , Humanos , Falência Renal Crônica/metabolismo , Cintilografia/efeitos adversos , Cintilografia/métodos , Compostos Radiofarmacêuticos/efeitos adversos , Medição de Risco , Uremia/metabolismo
4.
PLoS One ; 15(3): e0229233, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32119698

RESUMO

BACKGROUND AND OBJECTIVE: The SC+ haemodialysis system developed by Quanta Dialysis Technologies is a small, easy-to-use dialysis system designed to improve patient access to self-care and home haemodialysis. A prototype variant of the standard SC+ device with a modified fluidic management system generating a pulsatile push-pull dialysate flow through the dialyser during use has been developed for evaluation. It was hypothesized that, as a consequence of the pulsatile push-pull flow through the dialyser, the boundary layers at the membrane surface would be disrupted, thereby enhancing solute transport across the membrane, modifying protein fouling and maintaining the surface area available for mass and fluid transport throughout the whole treatment, leading to solute transport (clearance) enhancement compared to normal haemodialysis (HD) operation. METHODS: The pumping action of the SC+ system was modified by altering the sequence and timings of the valves and pumps associated with the flow balancing chambers that push and pull dialysis fluid to and from the dialyser. Using this unique prototype device, solute clearance performance was assessed across a range of molecular weights in two related series of laboratory bench studies. The first measured dialysis fluid moving across the dialyser membrane using ultrasonic flowmeters to establish the validity of the approach; solute clearance was subsequently measured using fluorescently tagged dextran molecules as surrogates for uraemic toxins. The second study used human blood doped with uraemic toxins collected from the spent dialysate of dialysis patients to quantify solute transport. In both, the performance of the SC+ prototype was assessed alongside reference devices operating in HD and pre-dilution haemodiafiltration (HDF) modes. RESULTS: Initial testing with fluorescein-tagged dextran molecules (0.3 kDa, 4 kDa, 10 kDa and 20 kDa) established the validity of the experimental pulsatile push-pull operation in the SC+ system to enhance clearance and demonstrated a 10 to 15% improvement above the current HD mode used in clinic today. The magnitude of the observed enhancement compared favourably with that achieved using pre-dilution HDF with a substitution fluid flow rate of 60 mL/min (equivalent to a substitution volume of 14.4 L in a 4-hour session) with the same dialyser and marker molecules. Additional testing using human blood indicated a comparable performance to pre-dilution HDF; however, in contrast with HDF, which demonstrated a gradual decrease in solute removal, the clearance values using the pulsatile push-pull method on the SC+ system were maintained over the entire duration of treatment. Overall albumin losses were not different. CONCLUSIONS: Results obtained using an experimental pulsatile push-pull dialysis flow configuration with an aqueous blood analogue and human blood ex vivo demonstrate an enhancement of solute transport across the dialyser membrane. The level of enhancement makes this approach comparable with that achieved using pre-dilution HDF with a substitution fluid flow rate of 60 mL/min (equivalent to a substitution volume of 14.4 L in a 4-hour session). The observed enhancement of solute transport is attributed to the disruption of the boundary layers at the fluid-membrane interface which, when used with blood, minimizes protein fouling and maintains the surface area.


Assuntos
Hemodiafiltração/instrumentação , Hemodiálise no Domicílio/instrumentação , Soluções para Diálise/química , Feminino , Hemodiafiltração/métodos , Hemodiálise no Domicílio/métodos , Humanos , Masculino , Fluxo Pulsátil , Toxinas Biológicas/análise
5.
Rev Assoc Med Bras (1992) ; 66Suppl 1(Suppl 1): s37-s44, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31939534

RESUMO

Peritoneal dialysis (PD) is a renal replacement therapy based on infusing a sterile solution into the peritoneal cavity through a catheter and provides for the removal of solutes and water using the peritoneal membrane as the exchange surface. This solution, which is in close contact with the capillaries in the peritoneum, allows diffusion solute transport and osmotic ultrafiltration water loss since it is hyperosmolar to plasma due to the addition of osmotic agents (most commonly glucose). Infusion and drainage of the solution into the peritoneal cavity can be performed in two ways: manually (continuous ambulatory PD), in which the patient usually goes through four solution changes throughout the day, or machine-assisted PD (automated PD), in which dialysis is performed with the aid of a cycling machine that allows changes to be made overnight while the patient is sleeping. Prescription and follow-up of PD involve characterizing the type of peritoneal transport and assessing the offered dialysis dose (solute clearance) as well as diagnosing and treating possible method-related complications (infectious and non-infectious).


Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal/métodos , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Soluções para Diálise/uso terapêutico , Humanos , Diálise Peritoneal Ambulatorial Contínua
6.
PLoS One ; 15(1): e0227281, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923235

RESUMO

Raman Chemometric Urinalysis (RametrixTM) was used to discern differences in Raman spectra from (i) 362 urine specimens from patients receiving peritoneal dialysis (PD) therapy for end-stage kidney disease (ESKD), (ii) 395 spent dialysate specimens from those PD therapies, and (iii) 235 urine specimens from healthy human volunteers. RametrixTM analysis includes spectral processing (e.g., truncation, baselining, and vector normalization); principal component analysis (PCA); statistical analyses (ANOVA and pairwise comparisons); discriminant analysis of principal components (DAPC); and testing DAPC models using a leave-one-out build/test validation procedure. Results showed distinct and statistically significant differences between the three types of specimens mentioned above. Further, when introducing "unknown" specimens, RametrixTM was able to identify the type of specimen (as PD patient urine or spent dialysate) with better than 98% accuracy, sensitivity, and specificity. RametrixTM was able to identify "unknown" urine specimens as from PD patients or healthy human volunteers with better than 96% accuracy (with better than 97% sensitivity and 94% specificity). This demonstrates that an entire Raman spectrum of a urine or spent dialysate specimen can be used to determine its identity or the presence of ESKD by the donor.


Assuntos
Falência Renal Crônica/urina , Análise Espectral Raman/métodos , Urinálise/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Confiabilidade dos Dados , Soluções para Diálise , Feminino , Voluntários Saudáveis , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal , Análise de Componente Principal , Sensibilidade e Especificidade , Adulto Jovem
9.
Water Res ; 168: 115157, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31614235

RESUMO

Hemodialysis is one of the therapies for patients with kidney failure. Hemodialysis requires large amounts of pure water, and is one of the most water-hungry medical procedures, and thus represents a clear opportunity where improvements should be made concerning the consumption and wastage of water. In this paper, we explored the potential of forward osmosis (FO) membrane for recycling the spent dialysate using the dialysis concentrate as the draw solution. Partially diluted dialysis concentrate could be further diluted with pure water to form dialysate for further dialysis process. Using commercial cellulose triacetate (CTA) FO membranes, the water recovery of approximately 64% was achieved and the final volume of the partially diluted dialysis concentrate was about four times the initial volume. Flux decline of the FO process was observed, mainly due to concentration of synthetic spent dialysate and dilution of dialysis concentrate, while membrane scaling had little impact on the flux decline. The urea rejection was found to be relatively low owing to the small size and electroneutral nature of the urea molecule. Obvious membrane scaling was observed after three FO cycles. The energy dispersive spectroscopy analysis of the scaling layer indicated that the scalants were phosphates and carbonates. The scaling was removed via osmotic backwash and almost completely recovery of FO flux was obtained. Economic analysis showed that the centralized treatment of spent dialysate in a dialysis center using the proposed osmotic dilution process could greatly save water resources and cost. Improving the urea rejection of FO membrane was identified as an important research focus for future research on the potential application of FO technology for recycling the spent dialysate in hemodialysis.


Assuntos
Purificação da Água , Análise Custo-Benefício , Soluções para Diálise , Estudos de Viabilidade , Membranas Artificiais , Osmose
10.
Ren Fail ; 42(1): 1-9, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31826694

RESUMO

Background: Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD), with high morbidity and mortality that requires an early diagnosis for effective treatment. PD withdrawal and bacterial peritonitis are important triggers for the onset of EPS. However, few studies have focused on cases of PD withdrawal without a clinical diagnosis of peritonitis, cirrhosis, or carcinomatosis. We aimed to compare the clinical characteristics and computed tomography (CT) images of patients with or without ascites in such situations and assess clinical outcomes in terms of mortality.Methods: Our retrospective review included 78 patients who withdraw PD between January 2000 and December 2017.Results: Ten patients had ascites, and 68 did not have a significant intra-abdominal collection. The ascites group had a significantly longer PD duration (months; 134.41 [range, 35.43-181.80] vs. 32.42 [733-183.47], p < 0.001) and higher peritoneal membrane transport status based on the dialysate-to-plasma ratios of creatinine (0.78 ± 0.08 vs. 0.68 ± 0.11, p = 0.009) and glucose (0.27 ± 0.07 vs. 0.636 ± 0.08, p = 0.001) than the control group. CT parameters, including peritoneal calcification, thickness, bowel tethering, or bowel dilatation, were not all present in each patient with ascites and EPS. During the 12-month study period, the ascites group had a higher risk for developing EPS (70% vs. 0%, p < 0.001) and a higher 12-month all-cause mortality (30% vs. 0%, p = 0.002).Conclusions: Ascites accumulation was not rare after PD discontinuation. A longer PD duration and high peritoneal membrane transport status could predict subsequent ascites accumulation. Furthermore, patients with ascites were at a higher risk of EPS.


Assuntos
Ascite/epidemiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Fibrose Peritoneal/epidemiologia , Peritonite/epidemiologia , Adulto , Idoso , Ascite/diagnóstico , Ascite/etiologia , Creatinina/sangue , Creatinina/metabolismo , Soluções para Diálise , Feminino , Seguimentos , Humanos , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Fibrose Peritoneal/diagnóstico , Fibrose Peritoneal/etiologia , Fibrose Peritoneal/patologia , Peritônio/diagnóstico por imagem , Peritônio/metabolismo , Peritônio/patologia , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Suspensão de Tratamento
11.
Ceska Slov Farm ; 68(4): 161-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31822109

RESUMO

This paper presents the comparable viability study results of the HepG2 and Vero cells in the presence of traditional peritoneal dialysis (PD) solutions determined by three methods (3-[4,5-dimethylthiazol]-2-yl-2,5-diphenyl tetrazolium bromide (MTT), neutral red (NR) and sulforhodamine B assays) with establishing different correlations between viability and quality indexes of the tested PD solutions. The obtained results confirmed cytotoxicity of the PD solutions even compared with an isotonic solution of sodium chloride. PD solutions action resulted in a similar reduction in the HepG2 and Vero cells. Moreover, this research found that metabolic cellular activity is more vulnerable to the action of PD solutions measured in the MTT-test. One more point is that cytotoxicity is related to pH of a solution and other unknown mechanisms, while glucose degradation products, glucose or lactate did not exert an exceptional negative action on PD solutions cytotoxicity. It is concluded that MTT-test is the best suitable for comparative studies of PD solutions which differ in pH values.


Assuntos
Materiais Biocompatíveis , Sobrevivência Celular , Soluções para Diálise/farmacologia , Animais , Chlorocebus aethiops , Glucose , Células Hep G2 , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico , Diálise Peritoneal , Células Vero
12.
J. bras. nefrol ; 41(4): 550-559, Out.-Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1056604

RESUMO

Abstract Fluid volume and hemodynamic management in hemodialysis patients is an essential component of dialysis adequacy. Restoring salt and water homeostasis in hemodialysis patients has been a permanent quest by nephrologists summarized by the 'dry weight' probing approach. Although this clinical approach has been associated with benefits on cardiovascular outcome, it is now challenged by recent studies showing that intensity or aggressiveness to remove fluid during intermittent dialysis is associated with cardiovascular stress and potential organ damage. A more precise approach is required to improve cardiovascular outcome in this high-risk population. Fluid status assessment and monitoring rely on four components: clinical assessment, non-invasive instrumental tools (e.g., US, bioimpedance, blood volume monitoring), cardiac biomarkers (e.g. natriuretic peptides), and algorithm and sodium modeling to estimate mass transfer. Optimal management of fluid and sodium imbalance in dialysis patients consist in adjusting salt and fluid removal by dialysis (ultrafiltration, dialysate sodium) and by restricting salt intake and fluid gain between dialysis sessions. Modern technology using biosensors and feedback control tools embarked on dialysis machine, with sophisticated analytics will provide direct handling of sodium and water in a more precise and personalized way. It is envisaged in the near future that these tools will support physician decision making with high potential of improving cardiovascular outcome.


Resumo O volume de fluidos e o controle hemodinâmico em pacientes em hemodiálise é um componente essencial da adequação da diálise. A restauração da homeostase do sal e da água em pacientes em hemodiálise tem sido uma busca constante por parte dos nefrologistas, no que condiz à abordagem do "peso seco. Embora essa abordagem clínica tenha sido associada a benefícios no desfecho cardiovascular, recentemente tem sido questionada por estudos que mostram que a intensidade ou agressividade para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos.para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos. Uma abordagem mais precisa é necessária para melhorar o desfecho cardiovascular nessa população de alto risco. A avaliação e monitorização do estado hídrico baseiam-se em quatro componentes: avaliação clínica, ferramentas instrumentais não invasivas (por exemplo, US, bioimpedância, monitorização do volume sanguíneo), biomarcadores cardíacos (e.g. peptídeos natriuréticos), algoritmos e modelagem de sódio para estimar a transferência de massa. O manejo otimizado do desequilíbrio hídrico e de sódio em pacientes dialíticos consiste em ajustar a remoção de sal e líquido por diálise (ultrafiltração, dialisato de sódio), e restringir a ingestão de sal e o ganho de líquido entre as sessões de diálise. Tecnologia moderna que utiliza biosensores e ferramentas de controle de feedback, hoje parte da máquina de diálise, com análises sofisticadas, proporcionam o manejo direto sobre o sódio e a água de uma maneira mais precisa e personalizada. Prevê-se no futuro próximo que essas ferramentas poderão auxiliar na tomada de decisão do médico, com alto potencial para melhorar o resultado cardiovascular.


Assuntos
Humanos , Sódio/metabolismo , Diálise Renal/efeitos adversos , Hemodinâmica/fisiologia , Homeostase/fisiologia , Falência Renal Crônica/terapia , Equilíbrio Hidroeletrolítico/fisiologia , Pressão Sanguínea/fisiologia , Algoritmos , Biomarcadores/metabolismo , Soluções para Diálise/química , Sistema Cardiovascular/fisiopatologia , Diálise Renal/normas , Resultado do Tratamento , Descondicionamento Cardiovascular , Nefrologistas/estatística & dados numéricos , Falência Renal Crônica/fisiopatologia
13.
PLoS One ; 14(11): e0224767, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721800

RESUMO

INTRODUCTION: The purpose of this study was to evaluate the impact of hemodialysis on the concentrations of sodium and potassium in the blood when a 25 g dose of sodium thiosulfate injection is infused over 60 minutes in combination with hemodialysis. METHODS: Sodium thiosulfate (25 g) was prepared by diluting 100 mL of 250 mg/mL Sodium Thiosulfate Injection with 800 mL of 5% dextrose. This was added to the circulating blood surrogate solution at a rate of 15 mL/minute using an infusion pump of an in vitro model of dialysis machine. Serial samples were collected before the administration of the sodium thiosulfate solution, after 15 minutes, 30 minutes, and 60 minutes of infusion from pre-and post-dialyzer ports in both the dialysate circuit and the extracorporeal circuit. FINDINGS: The concentration of sodium thiosulfate in pre-dialyzer and post-dialyzer samples of the circulating blood surrogate solution peaked at 30 minutes and 15 minutes, respectively and then remained relatively unchanged during the remainder of the infusion. Mean sodium concentrations (mEq/L) in the circulating blood surrogate solution collected after exposure to a dialyzer were 103.2 ± 12.2, 114.2 ± 18.8, 117.2 ± 7.5, 93.5 ± 5.9 at 0, 15, 30, and 60 minutes, respectively (p = 0.248). Mean potassium concentrations (mEq/L) in the circulating blood surrogate solution collected after exposure to a dialyzer were 1.4 ± 0.3, 1.6 ± 0.3, 1.5 ± 0.1, 1.2 ± 0.1 at 0, 15, 30, and 60 minutes, respectively (p = 0.365). Sodium and potassium concentrations in dialysate increased marginally after exposure to the dialyzer. DISCUSSION: Our study demonstrates that neither potassium nor sodium accumulated in circulating blood surrogate solution when a dose of sodium thiosulfate was infused in conjunction with hemodialysis.


Assuntos
Soluções para Diálise/química , Potássio/análise , Diálise Renal/métodos , Sódio/análise , Tiossulfatos , Substitutos Sanguíneos , Técnicas In Vitro
17.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31767714

RESUMO

Aluminum has no known biological function; however, it is a contaminant present in most foods and medications. Aluminum is excreted by the renal system, and patients with renal diseases should avoid aluminum-containing medications. Studies demonstrating long-term toxicity from the aluminum content in parenteral nutrition components led the US Food and Drug Administration to implement rules for these solutions. Large-volume ingredients were required to reduce the aluminum concentration, and small-volume components were required to be labeled with the aluminum concentration. Despite these rules, the total aluminum concentration from some components continues to be above the recommended final concentration. The concerns about toxicity from the aluminum present in infant formulas and antiperspirants have not been substantiated but require more research. Aluminum is one of the most effective adjuvants used in vaccines, and a large number of studies have documented minimal adverse effects from this use. Long-term, high-concentration exposure to aluminum has been linked in meta-analyses with the development of Alzheimer disease.


Assuntos
Alumínio/efeitos adversos , Soluções/química , Adjuvantes Farmacêuticos/química , Alumínio/análise , Alumínio/farmacocinética , Doença de Alzheimer , Antiperspirantes/química , Criança , Soluções para Diálise/química , Contaminação de Medicamentos/legislação & jurisprudência , Rotulagem de Medicamentos/legislação & jurisprudência , Regulamentação Governamental , Humanos , Lactente , Fórmulas Infantis/química , Recém-Nascido , Recém-Nascido Prematuro , Rim/metabolismo , Nefropatias/metabolismo , Nutrição Parenteral , Soluções/normas , Estados Unidos , United States Food and Drug Administration , Vacinas/química
18.
Blood Purif ; 48 Suppl 1: 1-6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31751990

RESUMO

BACKGROUND: Intradialytic hypotension (IDH) is a major challenge to safely performing haemodialysis. Blood volume depletion due to fluid removal is a major cause of hypotension, so more emphasis should be placed on finding alternative modalities to traditional constant rate ultrafiltration. SUMMARY: Intermittent back-filtrate infusion haemodiafiltration (I-HDF) utilises purified online quality dialysate with an automated dialysis machine. A bolus of 200 mL of dialysate is repetitively infused at 30-min intervals. A pilot study with 68 hypotension-prone patients revealed that I-HDF can reduce the frequency of IDH interventions, particularly in elderly patients and patients with large interdialytic weight gain (IDWG). This was typically accompanied by an increase in intradialytic blood pressure and decreased tachycardia in the latter half of the session, suggesting reduced sympathetic stimulation during I-HDF. Protective mechanisms involved in the pathophysiology of IDH could be explained in part by the findings obtained in this pilot study. Intermittent increases in blood pressure during I-HDF may prevent venous pooling (i.e., the DeJager-Krogh phenomenon), and reduced sympathetic stimulation may maintain a physiological state less likely to induce the cardio-vagal reflex (i.e., the Bezold-Jarisch reflex). The plasma refilling rate (PRR), evaluated as the refilling fraction (RF), is unexpectedly smaller in I-HDF. However, in patients who respond, the RF is well achieved, which suggests that adequate PRR is the central physiology for preventing IDH. Patients for whom I-HDF is effective are characteristically relatively elderly and show increased IDWG. Blood pressure increment and reduced sympathetic activation in I-HDF may be a mechanism for prevention of IDH. Key Messages: Evaluating relative changes in blood volume during I-HDF will provide a new perspective for exploring appropriate ultrafiltration modification that circumvents IDH.


Assuntos
Pressão Sanguínea , Hemodiafiltração/efeitos adversos , Hipotensão , Idoso , Soluções para Diálise/uso terapêutico , Humanos , Hipotensão/sangue , Hipotensão/etiologia , Hipotensão/fisiopatologia , Hipotensão/prevenção & controle , Pessoa de Meia-Idade
19.
Blood Purif ; 48 Suppl 1: 11-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31751993

RESUMO

BACKGROUND: In a typical hemodialysis (HD) session, excessive water removal sometimes induces peripheral circulatory failure and a rapid drop in blood pressure. Intermittent infusion hemodiafiltration (I-HDF), a new modality of dialysis therapy, has been developed to improve peripheral circulation by repeated intermittent infusion of dialysate during an HD session. In a typical I-HDF session, we infuse a volume of 200 mL of ultrapure dialysate by backfiltration at 150 mL/min every 30 min. The same volume is alternately removed from the patient's blood by filtration at a constant rate after each infusion. However, solute removal characteristics in I-HDF have not been clarified previously. We therefore conducted an in vitro study to investigate the characteristics of solute removal and the factors affecting such removal. SUMMARY: We used human plasma to evaluate the effects of filtration (QF)/infusion (QI) flow rates on solute clearance (CL) and to estimate the time-averaged solute CL (TACL) values. The CL values for all solutes decreased with increasing QI. For small molecules such as urea, the CL values predominantly decreased with increasing QI because of decreasing diffusive transport. For medium and large solutes such as ß2 microglobulin or larger, CL values predominantly increased with increasing QF because of increasing convective transport. However, the effects of these changes on TACL values were small compared with the CL value in a typical HD session because of the alternate filtration and infusion in I-HDF. Key Messages: Solute removal characteristics in I-HDF do not differ significantly from those in conventional HD treatment.


Assuntos
Pressão Sanguínea , Soluções para Diálise , Hemodiafiltração , Modelos Cardiovasculares , Humanos
20.
Blood Purif ; 48 Suppl 1: 17-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31752001

RESUMO

BACKGROUND: Intermittent infusion hemodiafiltration -(I-HDF) has been performed for a number of years since this mode of dialysis became available with dialyzers used in Japan. It has been effective in some cases and ineffective in others. In this study, we analyzed and clarified these differences. SUMMARY: We conducted a retrospective study to determine the factors affecting the effectiveness of I-HDF treatment in some patients and ineffectiveness in others and classified the complex causes associated with volume load that were identified. Key Messages: Bolus dialysate infusion in I-HDF affects the volume load (preload), and repeated bolus dialysate infusion influences both preload and afterload in patients with valvular heart disease. In this study, I-HDF was effective when brain natriuretic peptide levels, cardiothoracic ratio, and ultrafiltration rate were well controlled and cardiac load was low. I-HDF was shown to be effective in patients who are prone to developing hypotension at the end of a dialysis session. There were several factors, including different types of load, involved in inefficiency of I-HDF.


Assuntos
Soluções para Diálise/administração & dosagem , Hemodiafiltração/efeitos adversos , Hipotensão , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Hipotensão/prevenção & controle , Japão , Masculino , Estudos Retrospectivos
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